January 2019

Please select the dates (minimum 4) that you require after school care as well as the other fields.

For multiple participants from the same family, we ask that you complete this form again.

All Dates Listed Below
January 7-11, 2019
January 14-18, 2019
January 21-25, 2019
January 28- 31, 2019
Participant Information
Parent / Guardian Information
Other Information