Step 1 - Initial Application Form

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Gender *

Female

Male

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Phone Number *

(###)

###

####

Choose vacation season: *

SUMMER Vacation

SCHOOL Vacation

Please choose a SCHOOL Vacation season:

February

Choose attendance

Summer Vacation and School Vacation days are listed on the calendar

A: SUMMER VACATION: My child would like to attend the summer program at $130/day

B: SCHOOL VACATION: My child would like to attend the following days at $130/day

Additional $50/day if your child requires 1:1 supervision ($180/day)

Determined at our discretion (confirmed with caregiver)

Add Additional $50/day for 1:1 child supervision

Date *

MM

DD

YYYY