Earlybird Discount - Valid until May 10th
Use the Coupon Code: EarlyBird to receive a special $25 off per child / week APPLICABLE TO Full Day Option only - NOT APPLICABLE TO Extended care and Per day option.
Student Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date of Birth
Grade (Year 2023-2024)
*
Please Select
K
1
2
3
4
5
6
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 Name
Last Name
2 - Grade
*
Please Select
K
1
2
3
4
5
6
2 - School
*
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
Father Phone Number
*
Please enter a valid phone number.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
*
PAYMENT
“Earlybird” coupon code is only valid for a minimum of four week registration.
Registering For: Select all that applies
*
Full Day: 9 am - 3:30 pm
Half Day: 9 am-12 pm
Half Day: 12:30 - 3:30 pm
Per Day ($50/day) - 9 am-3:30 pm
Early Care: 7 am - 9 am
Aftercare: 3:30 pm - 6:00 pm
Per Day: Select your preferred day per week
*
Monday
Tuesday
Wednesday
Thursday
Friday
Per Day: Select your preferred Week(s)
*
Week 1: May 28 - May 31
Week 2: June 3- June 7
Week 3: June 10- June 14
Week 4: June 17 - June 21
Week 5: June 24 - June 28
Week 6: July 1 - July 5
Week 7: July 8- July 12
Week 8: July 15- July 19
Week 9: July 22- July 26
Week 10: July 29 - August 2
Week 11: Aug 5 - Aug 9
Select your preferred weeks (Minimum 4 weeks)
*
Categories:
All
All
Per Day
Full Day & Half Day
prev
next
( X )
Per Day
Per Day
9:00 am - 3:30 pm
$
50.00
Numbe of Days
1
2
3
4
Per Day - Early care
7:00 am - 9:00 pm
$
10.00
Number of Days
1
2
3
4
5
Per Day - Aftercare
3:30 pm - 6:00 pm
$
10.00
Number of Days
1
2
3
4
5
Full Day & Half Day
May 28 - May 31
May 27 Closed
$
175.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
June 10 - June 14
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
June 3 - June 7
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
June 18 - June 21
June 17 Closed - Juneteenth
$
175.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
June 24 - June 28
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
July 1 - July 5
July 4 Closed - Independence Day
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
July 8 - July 12
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30 - 3:30pm
July 15 - July 19
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
July 22 - July 26
$
199.00
Timings
9am-3:30pm
9am - 12pm
12:30pm - 3:30pm
July 29 - Aug 2
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
Aug 5 - Aug 9
$
199.00
Timings
9am - 3:30pm
9am - 12pm
12:30pm - 3:30pm
Early Care
per week
$
30.00
Number of Weeks (Should be same as camp)
1
2
3
4
5
6
7
8
9
10
11
Aftercare
per week
$
30.00
Number of Weeks (Should be same as camp)
1
2
3
4
5
6
7
8
9
10
11
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Enrollment & Payment Agreement
Please Read Carefully & Sign Below:
*
By signing below, i agree to the above Enrollment Agreement.
*
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
Submit
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