Summer GLAM Camp 2024 Registration

August 5th-16th (Mon-Fri) 9:00am-4:00pm

Name*
First Last
Age
Birthdate*
MM slash DD slash YYYY
Today’s Date*
MM slash DD slash YYYY
Parent/ Guardian Name*
Address*
Street Address City State Zipcode
Day Phone:*
Evening Phone:
Email*
Used to send you a receipt and important updates
Emergency Contact
Fill out this section if emergency contact is different from above.
Name*
First Last
Phone*
Relationship to child*
Authorized Pick Up List*
Please describe any learning or physical disabilities your child may have. Leave section blank if the latter doesn’t apply.
ENROLLMENT
Please check the Week Session(s) your child will be attending:*
- Entire Session: August 5th-16th (Mon-Fri) 9:00am-4:00pm
- Week 1: August 5th- August 9th (Mon-Fri) 9:00am-4:00pm
- Week 2: August 12th -16th (Mon-Fri) 9:00am-4:00pm
*Extended Care available 7:30am-6pm
Registration Fee
Hidden
Waiver
- I have read and agree to the Waiver and Release.
Registration Total
$0.00

Emergency Contact