Summer Registration

Please review our Summer Program Policies before registering. The registration and payment deadline is June 1st, 2017. 

Student First Name
Student Last Name
Program
Additional Program
Additional Program
Parent / Guardian First Name
Parent / Guardian Last Name
Address
City
State
Zip Code
Email
Phone Number
Emergency Contact
Emergency Number
Student Age
School Name (if applicable)
Discount or Promotion
Do you require Early Drop-Off at 8:30 a.m?
Do you require Late Pick-up at 5:00 p.m.?
Release
Signed Date
?
dd/mm/yyyy
How did you hear about our Summer Programs?
Payment: Payment is Accepted via Direct Checking Payment, Credit Cards through Paypal, or Checks mailed to NEMPAC. You will receive an e-invoice with your total due and instructions to pay! Thank you!