"When I walk in each day to pick up my son, the staff is always interacting with the kids..."
- Debbie Tye

Club Z

Summer Camp
&
After-school
Program

512.219.0700

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Enrollment Form

Because your child is important to us, most information is necessary. Please allow yourself 5-10 minutes to leave us as much helpful information as possible.Thanks. We're looking forward to extending our family with yours!

Items indicated with the '*' (asterisk) require your input.

Student Information

*First Name

*Last Name

*St. Address

Apt. Number

*City

*State/Zip

*Age

*Gender

*T-shirt

*Location(s) of Interest

Main Clubhouse (NW Austin)

Cedar Park/Leander
(NW of Austin)

New Life Assembly (S Austin)

Round Rock (N of Austin)

*Which program are you interested in?

Summer Care

After-school Care

*Requested Start Date (Summer or After-school)

Weeks child will be attending: (Summer only)

NOTICE: All Parents are financially responsible for ALL WEEKS they sign up for during Summer registration.

Entire Summer

May 28 - June 1

June 4 - June 8

June 11- June 16th

June 18 - June 22

June 25 - June 29

July 2 - July 6

July 9 - July 13

July 16 - July 20

July 23 - July 27

July 30 - Aug 3

Aug 6 - Aug 10

Aug 13 - Aug 17

Aug 20th - 24th (last day)

Contacts/Phone Numbers

*Mother:

*Father:

*Home Ph:

*Mother Cell:

*Father Cell:

Mother Wk:

Father Wk:

* Responsible Guardian Email(s):

Comments/Notes: Feel free to list allergies, make requests, etc. here.

Club Z

Summer Camp&After-schoolProgram

Enrollment Form

Student Information

Summer Camp
&
After-school
Program