ב"ה

Change Week Form

1. Parent information
Parents info*
First Name Last Name
Cell Phone*

Area Code Phone Number
E-mail*
2. Child's Information
Child 1*
First Name Middle Name Last Name
Currently enrolled *

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Change requested*

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Child 2
First Name Middle Name Last Name
Currently enrolled *

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Change requested*

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Child 3
First Name Middle Name Last Name
Currently enrolled *

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Change requested*

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Child 4
First Name Middle Name Last Name
Currently enrolled *

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
Change requested*

Full Summer ( June 23 - August 6)Week 1 (June 23 - June 26)Week 2 (June 29 - July 3)Week 3 (July 6 - July 10)Week 4 (July 13 - July 17)Week 5 (July 20 - July 24)Week 6 (July 27 - July 31)Week 7 (August 3 - August 6)
If you have additional children please add in the comments below
4. Payment Information
A $75 per child change week fee when you submit this form. This fee is non refundable.
Number of Children Making Changes*
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

General comments
Should be Empty:

This page uses TLS encryption to keep your data secure.

1. Parent information

2. Child's Information

4. Payment Information