Child's Last Name:  * Child's First Name:  * Parent or Legal Guardian's Last Name:  * Parent or Legal Guardian's First Name:  * Home Phone Number:  * Work Phone Number:  * Cell number: Address:  * City:  * State:  * Zip Code:  * Email Address: (optional) Last Grade Completed:  * T-Shirt Size Small (child)Medium (child)Large (child)Adult smallAdult mediumAdult largeAdult x-large Other T-shirt size: (Please specify)   Check which program your child will participate in: Pre-Enrichment Care for $75.00 per wk Enrichment Program for $65.00 per wk Full Summer Enrichment for $75.00 per wk Security code:   * Do not enter anything in this field:

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