Waiting List

Child Information
Name*
First Last
Date of Birth:*
During the school year:*
- I would like to attend ILDS
- I do not want to attend ILDS
During the summer:*
- I would like to attend ILDS
- I do not want to attend ILDS
Parent/Guardian Information
Name*
First Last
Phone*
Email*
Additional Parent/Guardian Information
Name
First Last
Phone
Email
Additional Comments

Child Information