Contact: aimee German (718) 623-8560

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ONLINE ENROLLMENT FORM

Please fill out form and online payment options will appear after submission.

LOCATION & SESSION DATES:

Please type Class Location

1st Parent Name Relation to Student    

Home Phone          Work Phone             

Cell Phone/Pager     Email    

Snail Mail address         City       

State   Zip Code    

Emergency Contact          Relation       

Emergency Contact Number        

Campers Name     Date of Birth    

Gender       

Grade     School    

Do you have any special needs or requests for you child?         

 Any additional information you would like us to know about your child?             

 How did you hear about us?

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