School Break Camps – Registration

Once we have received your waitlist form, our Administrative Director will reach out to confirm your application and provide more details.

School Break Registration Form

  • Child's Information

  • Select date MM slash DD slash YYYY
    Child's Birthdate
  • School Attending
  • Grade
  • Gender
  • Mother / Guardian Contact Information

  • Email
  • Father / Guardian Contact Information

  • Email
  • *If there is a custody order please include a copy with your registration
  • Emergency Contact Information

    Emergency Contact (Cannot be Mother or Father, must have a local address)
  • Emergency Contact Address
  • Cultural Background:
  • Please list any other relevant Information:

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