Contact Us If you’d like to contact us, you can use the form below or email us at email@example.com. You can also call Brooke at 484-202-0843. Child's First Name* Child's Last Name* Child's Birthday*(mm/dd/year) Child's Gender* MaleFemale Grade entering in Sept 2019* Pre-kindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeNot enrolled in a school program Your Email Address* School your child is attending* PublicPrivate My child has attended an LOFL program in the past (camp, enrichment or tutoring)* YesNo AM Literacy Camp (9:00 - 12:00) Session 1: July 8 – 19 (2 week session) Yes4th/5th one week only July 8-124th/5th one week only July 15-19 Session 2: July 29 – Aug 2 Yes Session 3: Aug 5 – 9 Yes PM Enrichment Camp for Ages K – 6th *(1:00 – 3:30) *lunch bunch included in cost if camper attends the AM literacy camp Register for full-day option: AM Literacy camp + included lunch bunch + afternoon enrichment (9:00 - 3:30) YesNo Register for Lunch Bunch + afternoon enrichment (12:00 - 3:30) YesNo Register for ONLY afternoon enrichment camp (1:00 - 3:30) YesNo Any other important information about your child (learning style, strengths, areas for growth, summer goals) Address Allergies/Health Issues/Current Medications Parent/Guardian #1 Name Parent/Guardian #2 Name Parent/Guardian #1 Phone # Parent/Guardian #2 Phone # Parent/Guardian #1 Email Address Parent/Guardian #2 Email Address Emergency Contact Name Emergency Contact # Health Insurance Provider/Policy # Approved Drivers Driver's Name Driver's Contact Number Driver's Relationship Driver's Name Driver's Contact Number Driver's Relationship Driver's Name Driver's Contact Number Driver's Relationship How did you hear about us?* ---Main Line camps siteFacebook PageNeighborhood EmailBrochureFriend/OtherAuction Camp Policies - Please click to read and check the appropriate boxes below I have read and agree to the camp policiesYes, I grant Little Ones for Literacy permission to publish my child's photographs on the Little Ones for Literacy website and other information sources (social media, flyers, brochures, etc.). I understand that photographs may be used to promote the camp's services as well as to offer information/resources and will not include any contact information.No, I do not grant Little Ones for Literacy permission to publish my child's photographs on the Little Ones for Literacy website.