Beit Fann Camp!
Registration Form
Child's Name
*
First Name
Middle Name
Last Name
Child's Age
*
Which date/s are you interested to book? Please Note, the completion of this form Does Not mean your booking is confirmed. You will receive a confirmation email for your booking.
*
Parent's Name
*
First Name
Last Name
Parent's Contact Number
*
Please enter a valid phone number.
E-mail Address
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EMERGENCY CONTACT INFORMATION
Name
*
First Name
Last Name
Phone Number
*
Are there any specific medical or health conditions that we should know about? incl. allergies and dietary requirements.
*
Please provide any additional information that may affect your child's ability to fully partake in our program:
*
I understand that this program will include activities at Beit Fann and around The Sustainable city community. In the event of illness, injury or accident, I authorize the program staff to act on my behalf and take the necessary step with the best interest of my child. In the event of an emergency, I understand that I will be notified as soon as possible.
*
I Agree
I Disagree
I give permission to Beit Fann, and/or parties designated by Beit Fann to photograph/video my child and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.
*
I Agree
I Disagree
I understand that fee's are required to confirm my child's space in the program and that no credit or refund will be given, if cancelation is less than 24 hours.
*
I Agree
I Disagree
By submitting this form I WAIVE, RELEASE AND DISCHARGE Beit Fann and The Sustainable City from any and all liability, including but not limited to, personal injury, property damage or loss.
*
I Agree
I Disagree
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Signature
*
Date
*
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Month
-
Day
Year
Date
Submit
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