Summer Camp 2025

End of Summer Discount - $30 OFF per Child

Coupon Code: Moms30

(Only applicable to Full Day 9:00 am - 3:00 pm)
Registering for
Student Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Date of Birth
Grade (Year 2024-2025)*
School*
School District*
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)*
2 - Student Name*

First NameLast Name
2 - Grade*
2 - School*
2 - School District*
Mother Name*

First NameLast Name
Mother Email*
example@example.com
Mother Phone Number*
Please enter a valid phone number.
Father Name*

First NameLast Name
Father Email*
example@example.com
Father Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Pickup*

Mother (as mentioned above)Father (as mentioned above)Other
Relation to the child*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mandatory Pickup/ Drop-Off Policies and Procedures*
PAYMENT

Minimum 4 Weeks Required
Registering For: Select all that applies*

Full Day: 9:00 am - 3:00 pmHalf Day: 9:00 am - 12:00 pmHalf Day: 12:00 pm - 3:00 pmPer Day ($55/day) - 9:00 am - 3:00 pmEarly Care: 7:00 am - 9:00 amAftercare: 3:00 pm - 6:00 pm

Select your preferred weeks (Minimum 4 weeks) *

Per Day

Per Day9:00 am - 3:00 pm

$55.00 Number of Days

Per Day - Early care7:00 am - 9:00 pm

$20.00 Number of Days

Per Day - Aftercare3:00 pm - 6:00 pm

$20.00 Number of Days

May & June

June 02 - June 05June 06 Closed (Prorated Week)

$220.00 Timings

June 09 - June 13

$249.00 Timings

June 16 - June 20June 19 Closed - Juneteenth (Prorated week)

$220.00 Timings

June 23 - June 27

$249.00 Timings

May 27 - May 30May 26 Closed (Prorated Week)

$220.00 Timings

July & August

June 30 - July 3July 4 Closed - Independence Day(Prorated Week)

$220.00 Timings

July 7 - July 11

$249.00 Timings

July 14 - July 18

$249.00 Timings

July 21 - July 25

$249.00 Timings

July 28 - Aug 1

$249.00 Timings

Aug 4 - Aug 8

$249.00 Timings

Early care per week7:00 am - 9:00 pm

$60.00 Number of weeks

After care per week 3:00 am - 6:00 pm

$60.00 Number of weeks

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Per Day: Select your preferred Week(s)*

Week 1: May 27 - May 30(May 26 Closed)Week 2: June 2- June 5(June 6th Closed)Week 3: June 10- June 14Week 4: June 16 - June 20(June 17 closed)Week 5: June 23 - June 27Week 6: June 30 - July 5(July 4 Closed)Week 7: July 7 - July 11Week 8: July 14- July 18Week 9: July 21 - July 25Week 10: July 28 - August 1Week 11: Aug 4 - Aug 8
Per Day: Select your preferred day for the above selected week*

MondayTuesdayWednesdayThursdayFriday
Enrollment & Payment Agreement
Please Read Carefully & Sign Below:*
By signing below, i agree to the above Enrollment Agreement.*

Clear
Date of Consent*

MonthDayYear
Date
How did you hear about us?*
Should be Empty:

PAYMENT

Enrollment & Payment Agreement