If your child is a student at The KeySpace, you can leave your name and email address blank (we already have your information). Children who are not our students are welcome to sign up too! If your child will be staying during lunch time, please have a packed lunch or we will bill you $5 for pizza. Thanks!

Child or Children Name(s)

Parent/Guardian Name(s)

Phone

(###)

###

####

Email Address

Select days:

Mon 12/24

Wed 12/26

Thu 12/27

Fri 12/28

Approximately which hours will your child be with us each day?

Emergency Contact Name

Emergency Contact Phone Number

(###)

###

####

Allergies and/or Dietary Restrictions

N/A if not applicable.

Anything else we should know?

Winter Break Camp