Summer Camp Application

Filing Directions

   Please answer ALL questions.
Print out the application for your records BEFORE submitting.
Press "Submit" button.
    
Student Last Name *
Student First Name *
Date of Birth *
Gender (M/F) *
Address *
City *
State *
ZIP *
Home Phone (xxx-xxx-xxxx) *
E-mail *
School Name
City (or School District)
Current Grade (in September) *
Current Math Subject
Mother's Name *
Work Phone  (xxx-xxx-xxxx)
Cell Phone  (xxx-xxx-xxxx)
Father's Name *
Work Phone  (xxx-xxx-xxxx)
Cell Phone  (xxx-xxx-xxxx)
Locations
Sessions July 7th - July 11th
July 14th - July 18th
July 21st - July 25th
July 28th - August 1st
Programs Full Day (8:30 am - 4:30 pm)
Half Day (8:30 am - 1:30 pm)
Afternoon Only (1:30 pm - 4:30 pm)
Services Early Arival (7:45 am - 8:30am)
Late Leave (4:30 pm - 5:15 pm)
"Ride Back Home"
Special Diet (specify)
  

Thank you for filling out our application form!
Please contact us to schedule an appointment
for the required Placement Test.
Call (510)-440-0929
Note! Your place will be secured only after you take the Placement Test and pay the required deposit.
For more information read the Information Bulletin