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2025 Summer Care
The maximum number of form submissions has been reached. This form is currently not available.
The SVDP Summer Program has a maximum enrollment of 50 full-time participants.
Please note this request form
does not guarantee your child has a place in the summer care program.
Once you submit the request form your child/children will be immediately placed on a waitlist. You will be notified no later than February 3
rd
if your child has been accepted into the summer program.
If your child is accepted into the summer program, the $140 registration fee will appear on your Blackbaud Tuition Management April statement. If your child is not accepted, you can then decide if you would like to remain on the waitlist and you will be notified if a spot opens.
Number of students to register
REQUIRED
Please fill out this field.
Student 1
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Fall 2025 Grade
REQUIRED
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Please fill out this field.
Days Attending
REQUIRED
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Please fill out this field.
T-Shirt Size
REQUIRED
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Please fill out this field.
Doctor:
REQUIRED
Please fill out this field.
Please enter valid data.
Clinic:
Please enter valid data.
Doctor's Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Dietary or Medical Needs:
Please enter valid data.
Other Concerns:
If medications need to be given, please print, fill out, and return the
permission form
Student 2
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Fall 2025 Grade
REQUIRED
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Please fill out this field.
Days Attending
REQUIRED
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Please fill out this field.
T-Shirt Size
REQUIRED
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Please fill out this field.
Doctor:
REQUIRED
Please fill out this field.
Please enter valid data.
Clinic:
Please enter valid data.
Doctor's Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Dietary or Medical Needs:
Please enter valid data.
Other Concerns:
If medications need to be given, please print, fill out, and return the
permission form
Student 3
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Fall 2025 Grade
REQUIRED
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Please fill out this field.
Days Attending
REQUIRED
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Please fill out this field.
T-Shirt Size
REQUIRED
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Please fill out this field.
Doctor:
REQUIRED
Please fill out this field.
Please enter valid data.
Clinic:
Please enter valid data.
Doctor's Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Dietary or Medical Needs:
Please enter valid data.
Other Concerns:
If medications need to be given, please print, fill out, and return the
permission form
Student 4
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Fall 2025 Grade
REQUIRED
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Please fill out this field.
Days Attending
REQUIRED
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Please fill out this field.
T-Shirt Size
REQUIRED
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Please fill out this field.
Doctor:
REQUIRED
Please fill out this field.
Please enter valid data.
Clinic:
Please enter valid data.
Doctor's Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Dietary or Medical Needs:
Please enter valid data.
Other Concerns:
If medications need to be given, please print, fill out, and return the
permission form
Parent Information
Please list which parent is to be called first:
Please enter valid data.
Parent Name(s):
REQUIRED
Please fill out this field.
Please enter valid data.
Address:
REQUIRED
Please fill out this field.
Please enter valid data.
City
REQUIRED
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Please enter valid data.
State
REQUIRED
AK
AL
AR
AS
AZ
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CO
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DE
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KS
KY
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Zip
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Please enter a zip code.
Email address you prefer we use for communications:
REQUIRED
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Please enter an email address.
Email address you prefer we use for communications:
REQUIRED
Please fill out this field.
Please enter an email address.
Best telephone numbers to reach you between 7:30 AM and 5:30 PM Monday-Friday:
Phone Number 1
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Phone Number 2
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Emergency Contacts (if parent cannot be reached)
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
I have read the
Summer Care Handbook
(click to read and download)
I Agree
Please select this field.
Because the SVDP Summer Care Program has budgeted and staffed for your child's attendance throughout the time period, you will be responsible for full summer payments if you choose to withdraw your child from care after May 17th, 2024
I Agree
Please select this field.
Signed (your name):
REQUIRED
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Please enter valid data.
Submit
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