Little Tiger 2025 3-Week Summer Camp Registration (Ages 3-11)

T-Shirt Size for Student 1*
T-Shirt Size for Student 2
T-Shirt Size for Student 3
T-Shirt Size for Student 4

Parent/Guardian Information
Parent/Guardian 1*

First NameLast Name
Mobile Number:*

Area CodePhone Number
Email Address:*
Parent/Guardian 2

First NameLast Name
Mobile Number:

Area CodePhone Number
Email Address:
example@example.com
Emergency Contact Information

(other than parents/guardians)
Emergency Contact Name:*

First NameLast Name
Emergency Contact Phone Number:*

Area CodePhone Number
Relationship to Student:*
Authorized Pick Up/Drop Off Person
Authorized Person #1 Name

First NameLast Name
Phone Number:

Area CodePhone Number
Authorized Person #2 Name

First NameLast Name
Phone Number:

Area CodePhone Number
Medical and Emergency Information
Medical problems, medicine to administer or any other limitations:
Physician's Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Physician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Emergency Care Facility *
Phone Number of Emergency Care Facility*

Area CodePhone Number
Address of Emergency Care Facility *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I give consent for the facility to secure any and all necessary emergency medical care for my child, when I/we cannot be contacted. I consent to an ambulance being called to transport the child, if necessary. I future agree to pay all costs incurred for transport.
yesNo
Peanut-Free School Policy
To ensure that we provide a safe environment for every student, Little Tiger is a peanut-‐free school. All foodsconsumed on the premises must be peanut-‐free. Please avoid sending any foods from home that may contain eventraces of peanuts or peanut products for lunches and snacks. Thank you for reading the ingredient labels on any food that yousend with your child for lunch or snack.

If, for some reason, a student brings a snack/lunch containing peanuts or manufactured in a factory or on equipment thatprocess peanuts, the item will be replaced with a peanut-‐safe and healthy snack. Little Tiger will provide safealternatives for snack in case of such event.
I read the policy above*

yes
Waiver of Liability
Waiver of Liability As a condition of enrollment, Parents agree to the following:

I acknowledge that I have voluntarily applied to allow my child toparticipate in the Little Tiger Summer Camp. I understand that during this Program, my child will be involved inactivities including, but not limited to: indoor and outdoor games, dancing, art, and numerous other physical activities, anyof which may result in injury or illness. By signing this form, I agree to release Little Tiger, the owner/lessor and/orlessee of the facility being used, and their associates, employees, volunteers, and independent contractors from any and allliability connected with the program. In case of any accident, I have left my emergency contact information. If I cannot be contacted, I allow persons associated with Little Tiger, to choose the proper medical treatment necessary. In the event of an accident or medical emergency, I will be financially responsible for any medical and transportation expenses involved.

In consideration of being admitted to Little Tiger Summer Camp, on behalf of myself, my family, my heirs and myassigns, I hereby release Little Tiger, its volunteers and contractors from liability for injury, loss or death to the above-mentioned participant while using any facility and its equipment now or in the future, resulting from the ordinary negligence of Little Tiger and its associates.
I agree with the waiver above.*

YesNo
Photo/Video
I agree to allow Little Tiger to photograph and/or video my child for all reasonable educational and promotional purposes without any compensation to my child or myself.
I agree to the photo/video policy stated above*

YesNoOther
By signing this wavier, I am promising that I read and agreed to the contents of the waiver.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Little Tiger 2025 3-Week Summer Camp Registration (Ages 3-11)

Student Information

Parent/Guardian Information

Emergency Contact Information

Authorized Pick Up/Drop Off Person

Medical and Emergency Information

Peanut-Free School Policy

Waiver of Liability

Photo/Video