Summer Camp Registration Form

Parent's Date Night

Registration is open

Duration: Fridays and Saturdays for the month of June

Parents night off is designed for children between 6 and 12 yrs old.

Meals:

Food, snacks and water will be provided.

Children must be registered before date night begins.

Evening Activities:

The Evening Activity Schedule is published on our Facebook page. Please connect with us at facebook.com/@CASCPHX

You will also receive a copy of the schedule and updates via email following confirmation of registration.

Location:

Campus Village West Plaza,

4920 W Thunderbird Rd, Ste 120ABC

Glendale AZ 85306

We cannot wait to have loads of fun!!

Child Name

First NameLast Name

Birth Date*

MonthDayYear

Age*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Parent 1*

First NameLast Name

Parent 2

First NameLast Name

Home Number

Area CodePhone Number

Cell Number (Parent 1)*

Area CodePhone Number

Cell Number (Parent 2)

Area CodePhone Number

E-mail (Parent 1)*

E-mail (Parent 2)

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Is there any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is there any prescribed any medications i.e inhaler or epipen? If yes, please explain any instructions.*

Summary of Planned Activities, Health Consent & Waiver I hereby give my approval for my child's participation in any and all activities prepared by {Charlie's Angels } Planned activities will vary weekly. Planned sessions will include dancing, jumping, running, and like movement that will engage the child in moderate to difficult physical activity. You are hereby consenting and waiving all related liability resulting from child's participation in such activities. You acknowledge that your child is in good health and able to take part in physical activity suitable for child's general age group.

Media Release & Consent*

I understand that pictures, photos and videos may be taken during my child's attendance to camp for Marketing, Advertising of the camp.  That my child may be directly or indirectly pictured or shown on these media types.  And, That these may be shared on social media platforms. I understand and consent to the release of media that shows my child.

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.

Name*

First NameLast Name

LIKE US and FOLLOW US to see how much fun we are having at camp @CASCPHX!

My Products*

Parents night off experience$25.00

Total $0.00

Credit Card

PLEASE NOTE: BY SUBMITTING THIS APPLICATION IT DOES NOT GUARANTEE A SPOT FOR YOUR CHILD. WE MUST RECEIVE YOUR FULL PAYMENT TO GUARANTEE A SPOT. PLEASE CHOOSE HOW YOU WILL MAKE YOUR DEPOSIT. FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE

Type a question

Parent's Night Off!!

Credit Card