Parent’s Name *

E-Mail *

Parent’s Phone *

Child’s Name *

Choose 2 Weeks in July *July Week 1 and 2July Week 1 and 3July Week 1 and 4July Week 2 and 3July Week 2 and 4July Week 3 and 4

Choose 2 Weeks in August *August Week 1 and 2August Week 1 and 3August Week 1 and 4August Week 2 and 3August Week 2 and 4August Week 3 and 4

Notes: