Kindermusik Summer Camp Application

Parents Name(s)*
Child's Name*
First Middle Last
Child DOB*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home/Cell Phone*
(primary phone)
Work Phone
Email*
Prefered Method of Contact

(home phone, work phone, email)
Select Class*
- Foundations - Cuddle and Bounce (Birth to Age 1)
- Level 1 - Sing and Play (Age 1 to Age 2)
- Level 2 - Wiggle and Grow (Age 2 to Age 3)
Select Your Schedule (Check all that apply)*
- Camp on the Farm | June 4, 6 and 7
- Camp Marvelous Me | June 18, 20 and 21
- Camp Yum | June 24, 25 and 26
- Camp Around Town | July 1, 2 and 3
- Camp Go Go Go! | July 9, 11 and 12
- Camp Splash | July 23, 25 and 26
Level 1 - 9:45 am - 10:30 am
Level 2 - 11:00 am - 11:45 am
Level 3 - 1:00 pm - 1:45 pm

Special Instructions of Information

Please provide any important information about your child and family that would be helpful for us to know including schedule, allergies, medications, and/or medical needs.