Spring Break Camp 2020

Mailing Address *

Virtual Reality Permission *

Yes No
DISD School ID
Please include if applicable. If you do not have the ID, please list the school name. As part of your child’s experience in SPARK! Summer Camps your child will participate in Dallas City of Learning (DCOL), an education initiative and online platform designed to help students discover new interests, develop skills and earn recognition for learning achievements. DCOL is a partnership with the City of Dallas and Dallas Independent School District, and is managed by Big Thought, a non-profit organization committed to closing the opportunity gap in Dallas. Some data you have provided, including student name, birth date and student ID number will be shared with DCOL to enable your child’s participation.
Physical Limitations *
Please type N/A if not applicable.
Health Restrictions *
(e.g. medications, injuries, etc.) Please type N/A if not applicable.
Dietary Restrictions *
Please type N/A if not applicable.

Parent/Guardian Information
If information is not available, please type N/A
Parent 1 *
Parent 1 Cell Phone *
Parent 1 Email *
Parent 2
Parent 2 Cell Phone
Parent 2 Email
Primary Parent Contact *
Authorized PickUp *
My child may be released to the above adult(s). NOTE: List ALL including parents, guardians, etc.

Emergency Contact Information
In case of an emergency in which the parent(s) cannot be reached, please call: (list name and number and relationship):
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone *

Informed Consent and Acknowledgment
Photo Release - I understand that my child may be photographed, and that these photographs may be included in any and all publications and/or websites of Dallas SPARK!

Medical Treatment Authorization - In the event that I cannot be reached to make arrangements for medical care, I hereby give consent for Dallas SPARK! to transport and secure any and all necessary emergency medical care for my child.

Consent and Certification - Dallas SPARK! offers various creative activities for its children. I give permission for my child to participate in any Dallas SPARK! related activity that my child attends. I understand that with any activity, there is the chance of injury to person or damage to property. Notwithstanding that risk, I release, relieve and hold harmless Dallas SPARK! its employees and volunteers from any and all liabilities, including liabilities resulting from injury to person or damage to property, arising out of my child's participation in Dallas SPARK! activity.

Policies and Procedures - Includes attire, cancellations, drop off/pick up info and more. Click here to download for your records.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Print Name *
Date *

Registration *

Early Bird Special till 2/14. Spring Break Week 1 - March 9-13 - Reserve the whole week and SAVE! $ 299.00

Early Bird Special till 2/14. Spring Break Week 2 - March 16-20 - Reserve the whole week and SAVE! $ 299.00

Early Bird Special till 2/14. Day by Day Camp Registration ($65.00 on or before 2/14/2020; $75.00 day of camp $ 65.00

Please select day(s) your child will attend.	Quantity
Monday, March 9th
Tuesday, March 10th
Wednesday March 11th
Thursday, March 12th
Friday, March 13th
Monday, March 16th
Tuesday, March 17th
Wednesday, March 18th
Thursday, March 19th
Friday, March 20th

Item subtotal: $ 0.00

Enter coupon

Total $ 0.00

How did you hear about SPARK! Spring Break day camp?
Payment Information:

Are you a SPARK! Member? Check your email for the coupon code to take advantage of your Member discount. Can't find the email? Call us at 214-421-7727.
Should be Empty: