Vacation School Registration
Child's First Name:
Child's Last Name:
Age: Choose One 5 6 7 8 9 10 11 12
Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Phone:
Address:
City:
State:
Zip:
Email:
Day: Choose One Full Day 5 Day Half Day 5 Day Full Day 3 Day Half Day 3 Day
(If 3 day choose days) Choose Three Monday Tuesday Wednesday Thursday Friday
School: Choose One Christmas Break February Break Spring Break
Drop Off/ Pick Up: Choose Which Applys Early Pick Up Drop Off
Signature