Summer Programming Enrollment Form
4th Grade - 6th Grade


We are happy to offer a three week Pathway focused summer day camp experience for current 4th-6th grade students who are enrolled in the Lansing School District. Our goal is to provide dynamic and engaging summer learning opportunities for all Lansing students. The programs will run Monday through Thursday from 9:00am until 3:00pm. Breakfast and lunch will be provided as well as bus transportation, if requested. Wrap around care is also available free of charge through the YMCA. Please select the day camp you would like your child to attend:
Please select the camp experience(s) you would like your child to attend.
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Pathway Focused Day Camps: June 18-21, June 25-28 and July 9-12
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Week long Camp Ebersole Overnight Experiences
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I am interested in chaperoning
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Please provide the following information to enroll your child in the program:
Does your child have an IEP or 504 plan?
Does your child have any allergies?
Will your child need to take any medication(s) while at day camp?
Race & Ethnicity: (Check all that apply)
Is transportation needed? Bus pick up and drop off location will be based on the home address on file in Synergy unless a change of address or child care request is completed.
Is wrap-around care needed?
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The following information is about the parents/guardians living at the same address as the student and others we may contact in case of an emergency. The school/program will contact and/or release the student to adults listed below:
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Third Contact:
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