Select your Camp(s)
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Fall Break Camp
Thanksgiving Camp
Winter Break Camp
Would you like to enroll your child for the 11/23 & 11/24 for $55 per day? *Camp for those two days will be confimed once we have a minimum of 5 enrollments
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Yes
No
Registering For:
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Please Select
Full Week Camp
Per Day Option - $50 / day
Student Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date of Birth
Grade
*
Please Select
K
1
2
3
4
5
School
*
School District
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Live Animal Show Consent
*
Allergies
*
To make it easier for us to understand and accommodate your child(ren)'s needs, please add any additional Educational Information about your child below (i.e. ADHD, Dyslexia, etc.) We would like to ensure the safety and value of your child(ren)'s enjoyment at our Camps as much as possible. (Note: You may put "N/A", if applicable)
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2 - Student Name
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First Name
Last Name
2 - Grade
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Please Select
K
1
2
3
4
5
6
2 - School
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2 - School District
*
Mother Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Father Name
*
First Name
Last Name
Father Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father Phone Number
*
Please enter a valid phone number.
Authorized Pickup
*
Mother (as mentioned above)
Father (as mentioned above)
Other
Relation to the child
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Mandatory Pickup/ Drop-Off Policies and Procedures
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PAYMENT
Select your Camp and Early/ Aftercare option(s):
*
Categories:
All
All
Fall Break: 10/14/2024 - 10/18/2024
Per Day
Thanksgiving Break: 11/25/2024 - 11/29/2024
Winter Break: 12/23/2024 - 01/03/2025
prev
next
( X )
Fall Break: 10/14/2024 - 10/18/2024
FBC: (Full Day)
9 AM - 3 PM
$
249.00
FBC: Early Care / Week
7:00 am - 9:00 am
$
50.00
FBC: After Care / Week
3:00 pm - 6:00 pm
$
50.00
Per Day
Per Day Option 9 AM - 3 PM
$
50.00
Number of Days
1
2
3
4
5
Thanksgiving Break: 11/25/2024 - 11/29/2024
TGC: (Full Day)
9 AM - 3 PM
$
249.00
TGC: Earlycare / week
7:00 am - 9:00 am
$
50.00
TGC: After care / week
3:00 pm - 6:00 pm
$
50.00
Winter Break: 12/23/2024 - 01/03/2025
Winter Break Camp (Full Day) Week 1
9 AM - 3 PM
$
249.00
Winter Break Camp (Full Day) Week 2
9 AM - 3 PM
$
249.00
WBC: Earlycare / Week
7:00 am - 9:00 am
$
50.00
Week(s)
Week 1
Week 2
Both Weeks
WBC: After care / Week
3:00 pm - 6:00 pm
$
50.00
Week(s)
Week 1
Week 2
Both Weeks
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Select your per day(s)
*
Monday
Tuesday
Wednesday
Thursday
Friday
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Enrollment Agreement
Please Read carefully & SIgn
By signing below, i agree to the above enrollment agreement.
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Date of Consent
*
-
Month
-
Day
Year
Date
How did you hear about us
*
Please Select
Facebook
Email
Instagram
Whatsapp
Friend
Masjid Newsletter
GEM Newsletter
Back to School Fair
Representative called
Received postcard
Other
I would be interested in
*
Thanksgivng Camp
Winter Break Camp
Spring Break Camp
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