springstreet.edu@gmail.com

Summer Explorer Application

Summer Explorer Application

Your first weeks payment is due with application, once we receive your application we will call you to complete your application and make payment arrangements.

All other payments are due at the beginning of each week.

Child’s Name:
Date of Birth:
Registration Choices
Parent / Guardian Name/s:
Street
City
State
Zip code
Parent / Guardian – Phone Numbers
Child’s Doctor
Doctor’s Phone Number
List Child’s Allergies If Any
List anyone other than parents who has permission to pick up your child and their phone numbers:
In the event of an emergency I give Spring Street Community Care & Recreation Inc. staff permission to obtain health care for my child.
Parent / Guardian Digital Signature
Today’s Date
Your Email Address

A copy of your child’s most recent Physical and Immunization records are required on start date.
Please pack a healthy lunch. Snacks are provided.