Guardian 1 Name *

First Name

Last Name

Guardian 1 Phone # *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 2 Name

First Name

Last Name

Guardian 2 Phone #

(###)

###

####

Child 1 Name *

First Name

Last Name

Child 1 Birthday *

Please note: your child needs to be 2 years old (or nearing 2) upon enrollment

MM

DD

YYYY

Child 2 Name

First Name

Last Name

Child 2 Birthday

Please note: your child needs to be 2 years old (or nearing 2) upon enrollment

MM

DD

YYYY

Choose your weeks:

Minimum 2 weeks

Week 1: (FRI 4th of July CLOSED) June 30-July 4 AFRICA

Week 2: July 7-11 NORTH AMERICA

Week 3: July 14-18 SOUTH AMERICA

Week 4: July 21-25 EUROPE

Week 5: July 28-Aug 1 AUSTRALIA

Week 6: Aug 4-8 ASIA

Week 7: Aug 11-15 ANTARCTICA

Week 8: Aug 18-22 THE OCEANS

Family household income *

You can base your response on the gross income on your most recent tax return.

Under $50K

$50K-125K

$125K-200K

$200K-275K

Over $275K

How did you hear about us?

Friend

Community Listserv

Facebook

Instagram

Online search

We have attended an Adult-Child class in the past

Neighborhood Flyer

Other