Brooklyn - Home
About Activities Schedule Rates Contact Photos
Staff - - - - -
Young People’s Day Camp
of Brooklyn
On-Line Pre-Enrollment Form!
  Exec. Director
John DiGennaro		 Phone
718.451.9700
   
 

OnLine Pre-Enrollment Form
 Phone 718.451.9700
 Email ypdcofbklyn@aol.com

   
  Pre-Enrollment Sign Up Form!
 

Parents/Guardian Information

 
First Name:
 
Last Name:
 
Address:
 
City:
 
State/County:
 
Cell Phone#
 
Zip Code
 
Home Phone#
 
Work Phone#
 
E-Mail
 

 
 
Credit Information
 For Enrollment Deposit of $100.00
  
Credit Card
 
Name
 
Card #
 
 
Month          Year
  
Number of Weeks
 
     
 
Child's Information
  
Name:
 
Birthdate:
 
Grade/Fall:
 
Address:
 

Child # 2 Information

  
Name:
 
Birthdate:
 
Grade/Fall:
 
Address:
 

Child # 3 Information

  
Name:
 
Birthdate:
 
Grade/Fall:
 
Address:
 

Additional Comments and/or Information

  
Comments: