Summer Registration Form Please fill and submit the form below to save your child’s spot in our summer program. Summer Registration Registration for New LEAPS Summer Program Step 1 of 4 25% Select Number of Weeks*Select the number of weeks you need for your child.One WeekTwo WeeksThree WeeksFour WeeksFive WeeksSix WeeksSeven WeeksEight Weeks1 Week Summer Program Price: $197.00 2 Weeks Summer ProgramPrice is $167.00 per week, enter 2 in the quantity section to pay for both weeks now, or enter 1 to pay for just one week now. Price: $167.00 Quantity: 3 Weeks Summer ProgramPrice is $155.00 per week, enter the quantity of weeks you'd like to pay for now in the quantity section. Price: $155.00 Quantity: 4 or 5 Weeks Summer ProgramPrice is $147.00 per week, enter the quantity of weeks you'd like to pay for now in the quantity section. Price: $147.00 Quantity: 6 or 7 Weeks Summer ProgramPrice is $137.00 per week, enter the quantity of weeks you'd like to pay for now in the quantity section. Price: $137.00 Quantity: Full 8 Weeks Summer ProgramPrice is $120.00 per week, enter the quantity of weeks you'd like to pay for now in the quantity section. Price: $120.00 Quantity: TotalTotal amount to be charged to your credit card. $0.00 Childs Name*Enter your child's name First Last Select Week(s)Select the week(s) you'd like your child to attend our Summer Program June 5 - 9 June 12 - 16 June 19 - 23 June 26 - 30 July 10 - 14 July 17 - 21 July 24 - 28 July 31 - Aug 4 Parent or Guardian Name*Enter parent or guardian's name First Last Phone Number*Enter a Phone Number where you can be reachedEmail*Enter an Email Address (to receive receipts) Billing AddressBilling Address - address where your card statements are sent. Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Total PurchaseThe total that will be charged to your credit card. $0.00 Credit Card*Enter Credit Card Information American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.