ECC Summer Camp Interest Form

If you are interested in having your child attend the St. Lucas Early Childhood Center Summer Camp, please complete the form below and our staff will contact you with additional information as soon as possible.

Parent's or Guardian's Last Name*

Parent's or Guardian's First Name*

Street Address*

City*

State*

Zip Code*

Telephone Number*

Email Address*

Child 1

Last Name*

First Name*

Age (Years)

(Months)

Child 2

Last Name

First Name

Age (Years)

(Months)

Child 3

Last Name

First Name

Age (Years)

(Months)

Home Church

Additional Comments or Information:

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