Language
English (US)
The Children's Corner Summer Camp 2023
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Returning TCC Student
*
Yes
No
Parent Name:
*
First Name
Last Name
Parent Email:
*
example@example.com
Parent Phone Number:
*
Please enter a valid phone number.
Second Contact (phone number required below, can be a second parent or other)
*
First Name
Last Name
Second Contact Phone Number
*
Please enter a valid phone number.
Parent 2 Name:
Parent 2 Email:
example@example.com
Parent 2 Phone Number:
Please enter a valid phone number.
Child's Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Days:
*
Monday- Friday (5 days a week)
Monday/Wednesday/Friday (3 days a week)
Tuesday/Thursday (2 days a week)
Hours per day (All Day - can pickup/drop off anytime between those hours):
*
Half day (2yr & younger 9:00am-12:30pm; 3yr+ 9:00am-1:00pm)
All day (7:30am-4:30pm)
Weeks:
*
Week 1: June 26-June 30
Week 2: July 3-July 7 (Closed Tuesday, July 4)
Week 3: July 10-July 14
Week 4: July 17-July 21
Week 5: July 24-July 28
Week 6: July 31-August 4
Week 7: August 7-August 11
Week 8: August 14-August 18
Week 9: August 21-August 24
How did you hear about The Children's Corner?
*
Please Select
Returning Student
Friend/Family Referral
Internet Search
Drove by
Social Media (Facebook, etc)
Publication Ad
Liberty Corner School PTO (TCC is a proud LCS PTO sponsor)
Other (please indicate in notes below)
Does your child have any allergies?
*
Yes, please include Allergy Action Plan to be completed with enrollment paperwork
No
Are there any custody arrangements we need to be aware of?
*
Yes, details and court documents will be provided with the enrollment paperwork
No
If there is any additional information you wish to share with us regarding your registration, please use the box below.
Signature
*
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