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 2021* 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 6 - 17 Yes Session 2: July 20 - 24 Yes Session 3: July 27 - 31 Yes PM Enrichment Camp for Ages K – 6th (1:00 – 3:30) (by checking yes, your child will be in our full-day camp option with lunch bunch included) Session 1: July 6 - 17 Yes Session 2: July 20 - 24 Yes Session 3: July 27 - 31 Yes August Tutoring While we cannot offer August LOFL camp this summer, our teachers will be available for tutoring sessions. If this interests you, please check off the box below and we will follow up with you in more detail. Yes, I am interested in August tutoring 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.