Summer Camp Registration Form

Mitchell Summer Camp

Thank you for your interest in Mitchell Learning Center!
Please fill out this registration form to be considered for our Summer Day camp program. After this form is submitted, we will contact you to schedule an interview to meet your lovely family! We will discuss your childcare needs and our philosophy. Space is limited so don't delay!
Parent #1 Name

First NameLast Name
Parent #2 Name

First NameLast Name
Child's Name

First NameMiddle NameLast Name
Child's Birth Date

MonthDayYear
Child's Gender
Address

Street Address

Street Address Line 2

CityState

Zip Code
Primary E-mail
example@example.com
Secondary E-mail
(optional)
Parent #1 Primary Phone Number
Format: (000) 000-0000.
Parent #2 Primary Phone Number
Format: (000) 000-0000.
Preferred Camp Schedule
Exceptional Childcare Needs
Additional Comments
If not full-time, please indicate preferred schedule.
Should be Empty:

Mitchell Summer Camp