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Your Name:

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Child's info:

Year of Birth:


Please enter the names and phone numbers of adults who MAY or MAY NOT pick up your child at the end of the day:

Please indicate if your child is a beginner or advanced in:
1) Chess
2) Robotics
3) Coding

Please list the names of any other X-Kids students your child would like to be grouped with:

Medical & emergency information: Please enter any allergies your child has, your child's doctor's name, insurance provider and policy number

In case of an emergency with your child, The X Kids staff may call an ambulance. If you DO NOT want us to call an ambulance, please explain what procedure you prefer us to follow. Otherwise, type "OK" in the box below.


Summer Camp Student

Summer Camp StudentM-F 9am-3pmEarly: 8am-9amExtended A: 3pm-4pm (MINECRAFT Club!)Extended B: 4pm-5pm (POKEMON Club!)Extended C: 5pm-5:30pm (Choice/Club Time)
Deposit Only #1
($299)

($50)

($0)

($50)

($25)
Deposit Only #2
($299)

($50)

($0)

($50)

($25)
Deposit Only #3
($299)

($50)

($0)

($50)

($25)
Deposit Only #4
($299)

($50)

($0)

($50)

($25)
Deposit Only #5
($299)

($50)

($0)

($50)

($25)
Deposit Only #6
($299)

($50)

($0)

($50)

($25)
Deposit Only #7
($299)

($50)

($0)

($50)

($25)
TOTAL: $0

For waitlist requests, or to change or cancel your registration, please contact us





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GRAND TOTAL:$0
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