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Register for JItterbug Summer Camp 2013
Child's Name
*
First
Last
Age
*
18m-2
2
3
4
5
6
7
8
9
10
11
12
Choose One
*
Boy
Girl
Date of Birth
*
Mother's Name
*
First
Last
Father's Name
*
First
Last
Phone Number
*
-
-
Phone Number
*
-
-
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Allergies
*
Caregivers Authorized for Pickup
*
Please indicate desired camp weeks:
*
Week 1: May 28-31
Week 2: June 3-7 (Sold out!-- Select to be put on waiting list.)
Week 3: June 10-14 (Sold out!-- Select to be put on waiting list.)
Week 4: June 17-21
Week 5: June 24-28 (Sold out!-- Select to be put on waiting list.)
Week 6: July 8-12
Weeks 7&8: July 15-26
Week 9: July 29-Aug 2
Week 10: Aug 5-9
Please select extended day options:
*
None
Monday
Tuesday
Wednesday
Thursday
Friday
Additional comments or questions:
*
Thank you for registering with Jitterbug! You will now be directed to the payment page, and w
e will contact you within 24 hours to confirm registration.
Please contact us with any questions!
Submit
