Student's Name *

New application must be completed for each student

First Name

Last Name

Student's date of birth *

MM

DD

YYYY

Is your child potty trained (only underwear - no pull ups)? *

Yes

No

Attendance Type

Full Time (4-5 days)

Part Time (1-3 days)

Half Days (8 a.m. - 12 p.m.)

What weeks should we expect your student? *

May 12th-16th (AHCS K4 & K5 only)

May 19th - 23rd

May 26th - 30th (no Camp on Memorial Day)

June 2nd - 6th

June 9th - 13th

June 16th - 20th

June 23rd - 27th

June 30th - July 3rd (no Camp on the 4th)

July 7th - 11th

July 14th - 18th

July 21st - 25th

July 28th - August 1st

August 4th - 8th

August 11th - 13th

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Name

First Name

Last Name

Phone

(###)

###

####

Mother's Name

First Name

Last Name

Phone

(###)

###

####