Participant Information

* Child's First Name

* Child's Last Name

* Birth Date

* Thacher Student

Adult Contact

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Address 1

Address 2

* City

* State

* Zip

* Phone

Alternate Phone

* Email Address

* Name:

* Relationship:

* Phone

Name:

Relationship:

Phone

2012 Children's House Programs - 50% will be subtracted from prices below. Please remember to pay balance by check before June 1, 2012.

2012 Children's House Programs

* Indicates Response Required