Summer Camp Email Reminder Signup

Parent 1 First Name (required)

Parent 1 Last Name (required)

Parent 2 First Name (required)

Parent 2 Last Name (required)

Parent 1 Phone Number (###)-###-####

Parent 2 Phone Number (###)-###-####

Parent 1 E-mail (required)

Parent 2 E-mail

Referred By (If Applicable)

Childs First Name

Childs Last Name

Child's Birthdate

Child's Gender Child's GenderMaleFemale

Child's Nickname (if applicable)

2nd Childs First name (if applicable)

2nd Childs Last Name (if applicable)

2nd Child's Birthdate (if applicable)

2nd Child's Gender (if applicable) 2nd Child's Gender (if applicable)MaleFemale

2nd Child's Nickname (if applicable)

Address

City

State

Zip Code

Child has attended (please check all that apply) Child has attended (please check all that apply) Preschool "Young 5's" Kindergarten CC Farm Camp Other

2nd Child has attended (please check all that apply) 2nd Child has attended (please check all that apply) Preschool "Young 5's" Kindergarten CC Farm Camp Other

Please use this space for any special notes about your child: