June 2019 Request Form

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.

June 3 - 6, 2019

* PA Day June 7, 2019

June 10-14, 2019
June 17 - 21, 2019
June 24 - 27, 2019

* PA Day June 28, 2019

Participant Information
Parent/Guardian Information
Other Information