Availability Request 2012

Number of Children:
Select how many children you would like to register.

1 Child

Full Name (First, Last):

Birthdate:

Gender:

Program:

Weeks Requested:
July 2 to 6 – Week 1
July 9 to 13 – Week 2
July 16 to 20 – Week 3
July 23 to 27 – Week 4
July 30 to August 3 – Week 5
August 7 to 10 – Week 6 (4-day week)
August 13 to 17 – Week 7
August 20 to 24 – Week 8

Additional Options:

Instructional Swimming:

Transportation:

Extended Hours:

Lunches:

Special considerations and/or comments:

Family Information

Parent 1 Name:

Parent 2 Name:

Home Tel: ( )

Business Tel: ( )

Fax: ( )

Email:

Address:

City: Postal Code:

Submit Your Request

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