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Kiddie Korner Camp 2025

Student Information
Child's Name*
First Name Last Name
Date of Birth*

Month Day Year
Child's Age in July 2024*
Gender*
Home Phone*
Cell Phone

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child Lives With*
Parent 1 Information
Full Name*
First Name Last Name
Cell Number*
E-mail*
Occupation

Work Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Work Phone Number
Parent 2 Information
Full Name*
First Name Last Name
Phone Number*
E-mail*
Occupation

Work Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Work Phone Number
Student Background
Previous/current school or playgroup*
Permssion to contact them
Contact information
Langauges spoken at home
Languages spoken by child*
Any special considerations?
How did you hear about Kiddie Korner Daycamp?
Camp
Select camp sessions*

July 1 - July 12July 15 - July 26July 29 - August 16All sessions
Select camp program*

9 am - 12 pm (half day)9 am - 3 pm (full day)8 am - 6 pm (daycare)
Note: We do not offer the half day program (9am - 12pm) option for children that are 4 or 5 years old, due to their schedules including special trips and programs.
Select days (we offer a 3 or 5 day week. Please select a minimum of three days.)*

MondayTuesdayWednesdayThursdayFridayAll
T-shirt size*
Number of t-shirts*
Parental Consent and Payment
Do you consent to allow your child to participate in supervised curricular and extracurricular activities that may include leaving the building?*

YesNo
I am fully aware that in case of extended closures due to COVID-19 cases, a pandemic, or any public health emergencies that may arise during summer camp or regular sessions, Kiddie Korner Preschool will not refund any tuition or deposit fees that were made prior to the school's closure. In addition, any new registrations will not be refunded, even if the child did not begin care.*

Yes
By typing your name, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Form.
Parent Signature*
Please choose amount according to how many t-shirts you ordered*

$110$120$130$140$150

Payment*

Credit Card Paypal

Postal / Zip Code

Country

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