YPDC ONLINE PRE-ENROLLMENT FORM
Last Name:
First Name:
Telephone No. Alt. Telephone No.
Email Address: Address:
Apartment #: City/Town:
State: Zip Code:

Camper

First Name :

Last Name:

Date of Birth : Sex:
Weeks Your Children Will Be Attending: (Minimum 2 Week Enrollment Per Child Required)

Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8

Additional Information:
You May Use This Space For Additional Campers; or
To Add Any Other Information That You Would Like Us To Have.