Mommy Poppins “Special” Explorer Registration

We’re so happy to have partnered with Mommy Poppins to offer this deal, and even more excited to work with your child!





Name of Parent/Guardian (required)

Your Email (required)

Mailing Address (required)

Telephone Number (required)

Where did you hear about us?
Kids Club Thirteen MommyPoppins Parents League Time Out New York Kids Flyer My Friend Other 

If “My Friend” or “Other,” please specify who or where:

Explorer 1 Information

Name:

Age:

Gender:

School:

Grade (for summer, please fill out grade in September):

T-shirt size:

Emergency Contacts (name, relationship to child and phone number):

1.

2.

Does your child have any allergies?

What are some of your child’s interests?

Are there activities your child shies away from?

What can you tell us about your child’s reading and writing?

Is there anything else you would like us to know about your child?

Select Trips

Summer Camp 2014:

Explorer 2 Information

Name:

Age:

Gender:

School:

Grade (for summer, please fill out grade in September):

T-shirt size:

Emergency Contacts (name, relationship to child and phone number):

1.

2.

Does your child have any allergies?

What are some of your child’s interests?

Are there activities your child shies away from?

What can you tell us about your child’s reading and writing?

Is there anything else you would like us to know about your child?

Select Trips

Summer Camp 2014:

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