Little Ones For Literacy

Little Ones for Literacy

Registration

Questions? Please feel free to call us (484) 202-0843 or email us.

Please fill in the following information.

If you are registering more than one child, please fill in a separate registration form for each child and we will email you a confirmation along with details regarding payment and our “Meet and Greet” dates (Saturday, June 1 and Saturday, June 8th).

Thank you!

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?*

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.