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516-401-4100

GRADY, EDU

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Educational Program School

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Youth Program

Registration

Is this your first time registering?

Yes

No

Parent/ Guardian Name:

Address

Primary Phone

Secondary Phone

Email

Child Attending Youth Camp

Age

Camp: June 29 - August 21

8 weeks

6 weeks

4 weeks

other

Indicate first start week

Bus Transportation. Pick up / Drop off from home?

Yes

No

Weekend Away: July 31 - August 3rd

Yes

No

Does your child have a food Allergy

Yes

No

If Yes, Please indicate the Allergies and Medication. (if No, state none)

Child shirt (Youth sizes) XS, S, M, L, XL, XXL

Upon enrolling in the summer youth program/camp. The registration fee is non-refundable.

Parent/Guardian

You're all sign up !!

Registration

Is this your first time registering?

Yes

No

Parent/Guardian Name :

Address

Primary Phone

Secondary Phone:

Email

Child Attending Youth Camp:

Age:

1399 Jerusalem Ave,

N. Merrick, NY 11553

516.401.4100