ECC Summer Registration Form

Summer Camp 2026 Registration Inquiry

Welcome to summer camp at The Muma and Grandpa Early Childhood Center at Congregation Beth-El Zedeck!

Child's Name

First

Last

Child's Date of Birth

Child's age as of June 1, 2026 (years and months)

Parent 1

Name

First

Last

Preferred Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent 2

Name

First

Last

Preferred Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

General Information

Please include any additional information we should know.

Camp Schedule

Choose dismissal time.

Early and After Care

After Care

Mark day(s) you wish to have after care for your child, which is anytime between 3:00 and 6:00 p.m. Monday-Thursday and 3:00 and 5:30 p.m. Friday.

Payment

Total

Item Quantity Qty Total

There are no products selected.

Check each week your child will attend. - June 1-5 1 $20.60

Check each week your child will attend. - June 8-12 1 $20.60

Check each week your child will attend. - June 15-19 1 $20.60

Check each week your child will attend. - June 22-26 1 $20.60

Check each week your child will attend. - June 29-July 2 1 $20.60

Check each week your child will attend. - July 6-10 1 $20.60

Check each week your child will attend. - July 13-17 1 $20.60

Check each week your child will attend. - July 20-24 1 $20.60

Total $0.00

Name on Card

First

Last

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Authorize.Net

Card Number

Expiration

Security Code