Summer Growth Program Application

*SUMMER 2022 APPLICATIONS ARE NOW CLOSED*

You can view, download or print our summer growth program application below:

PDF Version here:

In case of an emergency, notify: (List contact information for hours during Day Care -for example work address and phone if at work)

Names of individuals authorized to pick up child who are NOT listed above:

Health Information

The following information must be filled in by the parent/guardian. The intent of this information is to provide staff the background to provide appropriate care. Provide complete information so that we can be aware of your child's needs.

Allergies / Describe reaction and management of the reaction

Insurance