The Fun Starts Here! Register for Child Care/Camp Today!

Please enter all information in Mixed case (i.e. John Smith)

Fields in red indicate a required field.

Child's First Name
Child's Last Name
Date of Birth
Age
Gender
 Male
 Female
Grade


Mailing Address

Mailing Address 1
Mailing Address 2
City
State
Zip/Postal Code


Parent(s)/Guardian(s) Information

Parent/Guardian First Name
Parent/Guardian Last Name
Mailing Address 1 (if different)
Mailing Address 2 (if different)
City
State
Zip/Postal Code
Phone Number 1
Phone Number 2
Email Address
Additional Parent/Guardian Name
What Are You Registering For?
 Before/After School Care (Kids Express/Child Care)
 Adventure Club
 Summer Day Camp
 Kamp Kermit
 Safety Camp/Safety Camp Jr.


Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move


 

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