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Please enter YOUR information below
(Adult that is registerting child)

First Name *

Last Name *

Email *

Cell Phone *

(Compliance) Text Checkbox *

By checking this box I agree to receive email and SMS text communications and promotions from Kelli's Little Learners approximately 4 messages a month. SMS text and data rates may apply. I may opt out at any time by replying STOP. View Terms and Conditions at the bottom of this page.

Address *

City *

State *

Zip code *

2nd Parent Full Name

2nd Parent Cell Phone

2nd Parent Email

In addition to those listed above, the following individuals may pickup my child:

Authorized Adult 1 Full Name

Authorized Adult 1 Phone

Authorized Adult 1 Relation

Authorized Adult 2 Full Name

Authorized Adult 2 Phone

Authorized Adult 2 Relation

Authorized Adult 3 Full Name

Authorized Adult 3 Phone

Authorized Adult 3 Relation

Choose which Camp(s) and Session(s) your Child will Attend

Glow in the Dark Camp - Ages 3-9 (9:00-12:00)

Icebergs & Waterfalls Camp - Ages 3-9 (9:00-12:00)

Icebergs & Waterfalls Camp - Ages 5-12 (1:00-4:00)

How did you hear about us?

To keep our Summer Camps running smoothly, please agree to all of these policies:

I agree to pay the Camp Tuition by due date listed as well as the non-refundable registration fee to reserve my child’s place and pay for his/her camp supplies.

I give permission for my child’s photograph(s) and/or videotaping(s) to be used for preschool marketing materials offline and online, newsletters, and art projects. If I have a problem with this I will bring it up to the Director so she is aware that my child's photograph should not be used for preschool purposes.

Kelli's Little Learners owns a bounce house, and by allowing my child to use the bounce house during summer camp hours, I acknowledge the inherent risks and hazards, including the risk of serious injury or death. I voluntarily assume all associated risks and hazards, and I release the preschool and its affiliates from any claims arising out of my child's use of the bounce house. I understand and agree to the terms outlined in this agreement.

I agree to abide by the Policies & Procedures Handbook which I will receive.

Parent Agreement *

I agree to all of the policies listed on this form.

Parent Signature

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Date Signed

Please Fill Out This Form

Register your child into our Summer Camps by filling out the form below.