Request Information For:	Full Session (8 weeks) Any 7 Weeks Any 6 Weeks Any 5 Weeks First 4 Weeks Second 4 Weeks Leadership Training Program (entering 10th grade) Mini Day Program (3 and 4 year olds only)
An informational DVD and application will be mailed along with promotional information.

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First Name: Last Name: Address Line 1: Address Line 2: City: State: Zip: Country:

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Home Phone #: Work Phone #: Email Address: REQUIRED

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Child's Name	Date of Birth	Grade as of Sept. 2008
	January February March April May June July August September October November December 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
	January February March April May June July August September October November December 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
	January February March April May June July August September October November December 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

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