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.