FLB Summer Program Registration Form

FLB Summer Program Registration Form
Please fill out a registration form for each child. Waivers, medical form and payment will be required upon acceptance into the program. Please list the requested program date below. Below, please pick the start date of each week of the program you wish to enroll the child in. Cost per child is $150.00 USD per week unless multi-child or other discount is applicable.
Name of Child

First Name Last Name
Date of Birth for Child. Must be between 8 and 12 years old

Month Day Year

Address of Child

Address of Parent or Guardian *