ELSA'S MESSY SUMMER CAMP
BASIC INFORMATION
Camp
Dates: 3rd July 2022 - 31st August 2022
Price/ Week: 50 Bd
Price / Monthly (Early Bird Registration 40% Off) :136.8 Bd
Payment through Benefit Pay : +973 34095623
CHILD'S INFORMATION
Child's Name
Child's Age
DATE OF BIRTH (D.O.B)
Date Reservation (July 3-Aug 31)(Fri/Sat off)
Gender
Male
Female
Address
Street Address
Address
Street Address Line 2
Street Address Line 2
City
State / Province
Postal / Zip Code
City
Parent/Guardian Information
Name
Last Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name
Relationship
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
Alt. Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Elsa's Playground during the selected camp. In exchange for the acceptance of said child’s candidacy by Elsa's Playground. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Elsa's Playground and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Elsa's Playground including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
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
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