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
Format: (000) 000-0000.
Email
example@example.com
Child's Name
Birthdate
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Child's Name
Birthdate
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Child's Name
Birthdate
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Desired Start Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Arrival and Departure Times
School District
Possible Funding Source
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Submit
Should be Empty: