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  • Type/Date of event:  Summer Stretch 2018

    July 30th
    July 31st
    August 1st - Valleyfair day
    August 2nd

              August 3rd- half day 
    
    Individual(s) in charge:  Alannah Moran
    
    Transportation: Bus
    
    Cost of event: 

    $150.00 (Jr. High Participant)
    $70 (Sr. High Leader)
     

    Note: This is a fixed cost for the program regardless of the number of events participants attend.

    
     

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  • Household
    • Parent/Guardian Name 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 AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

      Zip REQUIRED Please fill out this field. Please enter a zip code.
    • Phone Number REQUIRED Please fill out this field. Please enter a phone number.
    • Email REQUIRED Please fill out this field. Please enter an email address.
    • Parent Chaperone
      
      A parent/adult (21+) is required to volunteer 2 shifts for valid Jr High registration
       

      Morning Shifts:      7:45AM - Noon
      Afternoon Shifts: 12:30PM - 4:30PM
    • Shift Preference REQUIRED (Select One) One all day shift Two half day shifts No preference Please fill out this field.
    • Availability July 30th - Morning  July 30th - Afternoon  July 30th - All Day (counts as two shifts) July 31st - Morning July 31st - Afternoon July 31st - All Day (counts as two shifts) August 1st - All Day (counts as two shifts) August 2nd - Morning August 2nd - Afternoon August 2nd - All Day (counts as two shifts) August 3rd- Morning

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  • • Number of Jr. High Participants to Register REQUIRED Please fill out this field.
    • Jr. High Participant 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.
      • Gender REQUIRED Please fill out this field.
      • T-Shirt (Adult sizes) REQUIRED (Select One) Please fill out this field.
      • Dates Teen Attending
      • Fee$150.0

    • Jr. High Participant 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.
      • Gender REQUIRED Please fill out this field.
      • T-Shirt (Adult sizes) REQUIRED (Select One) Please fill out this field.
      • Dates Teen Attending
      • Fee$150.0

    • Jr. High Participant 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.
      • Gender REQUIRED Please fill out this field.
      • T-Shirt (Adult sizes) REQUIRED (Select One) Please fill out this field.
      • Dates Teen Attending
      • Fee$150.0

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  • • Number of Sr. High Leaders to Register REQUIRED Please fill out this field.
    • Sr. High Leader 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.
      • Gender REQUIRED Please fill out this field.
      • T-Shirt (Adult sizes) REQUIRED (Select One) Please fill out this field.
      • Dates Leader Attending
      • Fee$70.0

    • Sr. High Leader 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.
      • Gender REQUIRED Please fill out this field.
      • T-Shirt (Adult sizes) REQUIRED (Select One) Please fill out this field.
      • Dates Leader Attending
      • Fee$70.0

    • Sr. High Leader 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.
      • Gender REQUIRED Please fill out this field.
      • T-Shirt (Adult sizes) REQUIRED (Select One) Please fill out this field.
      • Dates Leader Attending
      • Fee$70.0

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  Total: $

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