Child's Name *

First Name

Last Name

D.O.B. *

MM

DD

YYYY

Select *

Male

Female

Confirm Location *

Park Slope

Prospect Heights

Parent/Guardian *

#1

First Name

Last Name

Cell Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian *

#2

First Name

Last Name

Cell Phone *

(###)

###

####

Address

If different from above

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

Please add 3 local people other than yourself

First Name

Last Name

Cell Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Cell Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Cell Phone *

(###)

###

####

Summer Camp fee selection *

$400 one-time summer camp fee

I agree to pay summer camp tuition *

Yes

No

All payments and deposits are final *

By accepting I understand that deposits and fees are NON-REFUNDABLE or NON-TRANSFERABLE

Accept

Do not accept