The Learning Center
at Third Street Alliance Summer Camp Inquiry Form
*For our Summer School Age Camp we require a $50 activity fee for material and field trips.
Parent/Guardian's Name
Contact Phone Number
Email
example@example.com
Child's Name
Birthdate
/
Month
/
Day
Year
Date
Age
Child's Name
Birthdate
/
Month
/
Day
Year
Date
Age
Child's Name
Birthdate
/
Month
/
Day
Year
Date
Age
Desired Start Date
/
Month
/
Day
Year
Date
Child's Arrival and Departure Times
School District
Possible Funding Source
Preview PDF
Submit
Should be Empty: