summer camp 2024 - Registration form Child’s Name: * Date of Birth * Age * Gender * Please check one F M Home Address: * Name (s) of Parent/Guardian * Email Address * Work * Cell Phone * Place of work * Phone Number * Name of another person authorized to pick up your child if different from the above Full Name * Tel No * Emergency Purposes Name and telephone number of other person(s) that could be contacted in case of an emergency: Name * Tel No * Relationship * Name * Tel No * Relationship * Medical Information Child’s primary care doctor Tel No Preferred hospital in case of an emergency Any known medical problems or allergies: Any special needs? Any additional information you want us to know about your child? Signature I understand that I will need pay The Kids Social Club: Choose your week Week 1 - Under the Sea Week 2 - Safari Explorers Week 3 - Superhero Training Camp Week 4 - Garden Gurus Week 5 - Outer Space Week 6 - Circus Spectacular Week 7 - Lego Week 8 -Ocean ParentSignature * Date * I accept Class Policies Thank you!
