Please fill out the Winter Break Registration form completely. Fields marked with * are required.
Child Name: *
Child Age: *
Child's DOB:
Mother/Guardian Name: *
Mother/Guardian Email: *
Mother/Guardian Phone Number: *
Father/Guardian Name:
Father/Guardian Email:
Father/Guardian Phone Number:
Winter Break Week Selection: (Check all that apply) * Week 1
Winter Break Program: (Select One) * Winter Break - Full ($170 /week)Winter Break - Daily ($45 /day)
Comments:
