Club Member Application Form


  • You must fill out one form per child.
  • Required fields are noted with an asterisk (*). We encourage you to fill out each field of the form completely.  If the question does not apply to you or your child, please enter “N/A”.
  • Please review our Medication Policy found on page 11 of the Parent/Guardian Handbook here before filling out the Medications section of the form below.
  • NO payment required with application form.

Completing the application form does not guarantee admission into the 2020 summer program.

Youth Information

Household Information

Assistance/Income Information

Academic Information


Medical Information


All medications required to be in original container with child's first and last name on it. Please refer to our Medication Policy that is outlined on page 11 of our Parent/Guardian Handbook (linked above).

Health and Wellness

Primary Parent/Guardian Information

Secondary Parent/Guardian Information (Optional)

Emergency Contacts

Contact 1*

Contact 2*

Contact 3 (Optional)

Contact 4 (Optional)

Transportation Information

Bonafide Reason for Needing Care

Bonafide is defined as a work, school, or medical conflict that causes no adequate supervision in your household to be available for your child(ren). Additional documentation may be required.
I attest that my family has a bonafide reason for needing care.