Fall Junior's Day Camp

November 4th, 9am-3:30pm | Please fill out this form and click submit! I can't wait to see your kiddos. Email with any questions!

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Emergency Contact Name

*

Emergency Contact Number

*

Payment

1 child ($40.00) 2 children ($50.00) 3 children ($60.00)

Amount

Child 1 Information

Name

*

Grade

*

Please select one option.

Kinder 1st 2nd 3rd

Any Allergies/ dietary restrictions?

*

Child 2 Information

Name

*

Grade

*

Please select one option.

Kinder 1st 2nd 3rd

Any Allergies/ dietary restrictions?

*

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

November 4th, 9am-3:30pm

Please fill out this form and click submit! I can't wait to see your kiddos. Email with any questions!

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