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Summer Celebration (lectureship)
>
Children's Registration Form
2009 Children Program Registration
Please complete this for
up to three children registering.
The Children's Program is for children ages 0 to 12 (entering sixth grade) Older children should be registered in the Teen Program.
Summer Celebration Adult Contact Last Name
Summer Celebration Adult Contact First Name
Email Address
Street Address
City
State
Zip Code
Cell Phone Number
Alternate Cell Phone Number
Number you can be reached while at Summer Celebration
Where you are staying while at Summer Celebration
The
Nursery
is for children ages
infant to 23 months
. It is available from 9:30-Noon and from 2-4:30 p.m.
Preschool Day Care
includes
ages 2-Kindergarten.
Classes will be provided from 9:30 AM -Noon and 2-4:30 PM.
Day Camp
is for children entering
first grade through age 12.
Hours will be 8:30 a.m. until 4:30 p.m. and includes lunch.
CHILD 1
first name
CHILD 1 last name
Enroll CHILD 1 in
Nursery (0-23 months)
Preschool (2 yrs -beginning kindergarten)
Day Camp (completed kindergarten-age 12)
CHILD 1 Allergies or other medical conditions that require special attention
CHILD 1 Birthdate (mm/dd/yyyy)
Please check
boy
girl
For Day Camp, grade for 2008-2009
Please register CHILD 1 for
Two Days
Other
If other, please specify
CHILD 2
first name
CHILD 2 last name
Enroll CHILD 2 in
Nursery (0-23 months)
Preschool (2 yrs -beginning kindergarten)
Day Camp (completed kindergarten-age 12)
CHILD 2 Allergies or other medical conditions that require special attention
CHILD 2 Birthdate (mm/dd/yyyy)
Please check
boy
girl
For Day Camp, grade for 2008-2009
Please register CHILD 2 for
Two Days
Other
If other, please specify
CHILD 3
first name
CHILD 3 last name
Enroll CHILD 3 in
Nursery (0-23 months)
Preschool (2 yrs -beginning kindergarten)
Day Camp (completed kindergarten-age 12)
CHILD 3 Allergies or other medical conditions that require special attention
CHILD 3 Birthdate (mm/dd/yyyy)
Please check
boy
girl
For Day Camp, grade for 2008-2009
Please register CHILD 3 for
Two Days
Other
If other, please specify
Please use another form to enroll additional children.
* Type
both words
below,
separated by a space
.
Can't read the words below? Try
different words
or an
audio captcha
.
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