Child's First Name     Child's Last Name

Street Address

City      State      Zip

Phone Number

Email Address

Older Toddler (25 months - 36 months)       Older Children (37 months - 5 years)

Kindergarten (Must be 5 years old by November 15th)     Summer Camp

1st Grade   2nd Grade   3rd Grade   4th Grade  

5th Grade   6th Grade    7th Grade   8th Grade

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