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YCCFA Registration & PayPal Payment (#2) (#7) (#8) (#14)

Facility Address:
YCCA: 929 S. Water Street Philadelphia, Pa. 19147 (215-336-3324)

YCCAon2:
1714-20 S. 2nd Street Philadelphia, Pa 19148 (267-928-4808)

Application for Summer Camp 2024

July 8th-August 23rd

A $100 deposit must accompany the completed application.

About the Child

Fill out some information about the child you are registering.

Child’s full name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Child's Birth Date

Health Status

Location and Schedule

Please make some choices related to where and when you would like the child to attend.

Please select one or both locations

929 S. Water Street

1714 S. 2nd Street

Scheduled Days

Monday

Tuesday

Wednesday

Thursday

Friday

Length of days

Full days (8:30-3:30 p.m)

Extended Day (7:30-5:30)

Afternoon Extended 8:30-5:30)

Morning Extended (7:30-3:30)

Afternoon Program (3:15-5:30)

Please write specific schedule if not listed above

About the Parents

Fill out some information about the parents of the child.

First Name

Last Name

First Name

Last Name

Relationship

Marital status

Single

Married

Separated

Divorced

Living together

Parent #1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent #2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent #1 Phone/Mobile

Parent #2 Phone/Mobile

Parent #1 Email

Parent #2 Email

Best way to contact you (for non-emergencies)

Young Children’s Center For The Arts provides its community with an inclusion program that warmly embraces each and every young child, regardless of race, religion, ethnicity, and development.

Approval & Payment

Parent name

This signifies parental approval.

First Name

Last Name

Date

Payment

You may pay using credit card

Registration Fee

Price: $100.00

Pay with Card (Stripe)

Coupon

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