Child's Name Child's Grade Completed (as of June 12, 2019) Your Daytime Phone Number Please check the dates you would like to schedule care below. This will replace your original schedule.Please be sure to mark all dates that you need care with a checkmark.All dates that you do not need care should be unchecked. Full Week 6/18-21 June 18 June 18 June 19 June 19 June 20 June 20 June 21 June 21Full Week 6/24-28 June 24 June 24 June 25 June 25 June 26 June 26 June 27 June 27 June 28 June 28Full Week 7/1-5 July 1 July 1 July 2 July 2 July 3 July 3 July 5 July 5Full Week 7/8-12 July 8 July 8 July 9 July 9 July 10 July 10 July 11 July 11 July 12 July 12Full Week 7/15-19 July 15 July 15 July 16 July 16 July 17 July 17 July 18 July 18 July 19 July 19Full Week 7/22-26 July 22 July 22 July 23 July 23 July 24 July 24 July 25 July 25 July 26 July 26Full Week 7/29-8/2 July 29 July 29 July 30 July 30 July 31 July 31 August 1 August 1 August 2 August 2Full Week 8/5-9 August 5 August 5 August 6 August 6 August 7 August 7 August 8 August 8 August 9 August 9Full Week 8/12-16 August 12 August 12 August 13 August 13 August 14 August 14 August 15 August 15 August 16 August 16Full Week 8/19 August 19 August 19 Parent/Guardian Signature Sign above by holding down the left button of your mouse of by using your finger in the gray area.
