Name of Parent/Guardian
Primary Phone Number cell work home
Secondary Phone Number cell work home
Email
What session are you presently interested in?
School Year Summer Camp
School Year Service Type: ---before schoolafter schoolbefore and after school
Summer Camp Service Type: ---1-3 weeks out of the Summer4-6 weeks out of the SummerFull-Timer Service (every week offered)
How soon would you like service? ---immediatelynext couple of weeksin a month or sostart of next session
How many children will need service? ---123456more than 6
Check child or children's current grade(s): kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade
Please select your child's school (if more than one, your youngest child's):
---Harrisburg Christian SchoolSaint Margaret Mary SchoolSara Lindemuth ElementaryTW Holtzman Jr. ElementaryOther
If other, please provide name of school below (note: we currently receive before & after school busing for Susquehanna Township residents only):
Please let us know how you heard about us ---advertisementccisenrolled parentfacebookschoolweb searchother
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For any other request, questions, comments, or concerns please contact us at hello@laingyouthclub.com.