Request to Enroll in Summer Care 2023

The SVDP Summer Program has a maximum enrollment of 45 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 $130 registration fee will appear on your Blackbaud Tuition Management March 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 2023 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 2023 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 2023 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 2023 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 Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
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 19th, 2023

I Agree Please select this field.

Signed (your name): REQUIRED Please fill out this field. Please enter valid data.