FIRST NAME                          LAST NAME

STREET ADDRESS                                                                       APT #

CITY                                     STATE                ZIP

AGE       SEX( M or F)

LOCATION

Main Clubhouse (Northwest)   Liberty Hill (Northwest)   Legacy Oaks (South)

Hyde Park (Central)                Round Rock (North)

PROGRAM

Summer Care    After-School  (N/A for Hyde Park Location)

REQUESTED START DATE   (Summer or After-School)

WEEKS ATTENDING: (Summer Care 2008 Only)

   05/27 - 05/30       07/14 - 07/18

   06/02 - 06/06       07/21 - 07/25

   06/09 - 06/13       07/28 - 08/01

   06/16 - 06/20       08/04 - 08/08

   06/23 - 06/27       08/11 - 08/15

   06/30 - 07/04       08/18 - 08/22

   07/07 - 07/11       08/25 - 08/29

T-SHIRT SIZE:

Youth     Small     Medium     Large     X-Large

PARENTS NAME(S)                                          

CONTACT PHONE NUMBERS:

Home     Work     Mobile

EMAIL ADDRESS:                                        

Note:  A valid email address is required for online registration.  A confirmation reply email will be sent to the email provided along with important information. 

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