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Kindergarten Countdown Camp Application (2024)
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33
Questions
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1
Enter Your Child's Name/Como se llama su hijo/hija?
*
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First Name/Nombre
Last Name/Apellido
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2
Enter Your Child's Birth Date/Ponga la fecha de nacimiento de su hijo/hija
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Date
Year
Month
Day
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3
Gender/Genero
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4
What school will your child attend in the fall?/A que escuela asistira su hijo/hija en el otono?
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Please Select
Amelia Earhart
Edgelea
Glen Acres
Miami
Miller
Murdock
Oakland
Vinton
Battleground
Burnett Creek
Dayton
Hershey
James Cole
Klondike
Mayflower
Mintonye
Woodland
Wea Ridge
West Lafayette
Wyandotte
Please Select
Please Select
Amelia Earhart
Edgelea
Glen Acres
Miami
Miller
Murdock
Oakland
Vinton
Battleground
Burnett Creek
Dayton
Hershey
James Cole
Klondike
Mayflower
Mintonye
Woodland
Wea Ridge
West Lafayette
Wyandotte
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5
Is your child registered at this school? / ¿Esta registrado en esta escuela?
*
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YES
NO
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6
Please list any dates your child will not be able to attend camp (Put zero if no dates.) / Por favor,
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7
Parent/Guardian Name (Padre / Gaurdián)
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8
Relationship to Child / Relacion con el nino
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9
Parent 1 Phone Number / Numero de telefono
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10
Parent 1 Email Address (Padre / Gaurdián Correo electrónico)
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11
Parent 1 Primary Address / Dirección
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12
City, State, Zip / Ciudad, Estado, Código Postal
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13
Parent/Guardian Name 2 (Padre /Gaurdián 2)
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14
Phone Number Parent 2 / Numero de telefono
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15
Relationship to Child / Relación con el niño:
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16
Parent/Guardian Email 2 (Correo electrónico)
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17
Address / Dirección
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18
City, State, Zip / Ciudad, Estado, Código Postal
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19
Other Emergency Contact 1 / Contacto de emergencia 1
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20
Other Emergency Contact 1 Phone/ Contacto de emergencia Teléfono
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21
Other Emergency Contact Relationship to Student / Contacto de emergencia
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22
Does your child have any medical issues we should know about? If so, please explain below. / ¿Su hijo tiene alguna alergia?
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23
Does your child have any food allergies? / Tiene su hijo/hija alergias alimentarias?
*
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Please refer to the submission page at the end of this application for a food allergy form that must be submitted to the school or to Kelci Fox at kfox@uwlafayette.org in order to ensure that your child has food options available at camp that will not cause an allergic reaction.
YES
NO
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24
Has your child attended GLASS? /. ¿Su hijo ha sido asistido a GLASS? *
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YES
NO
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25
What services have they received at GLASS? / Que servicio a recibido allí?
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26
Where does your child receive health care? / ¿Dónde recibe atención médica su hijo?
*
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27
Medications / Medicamentos
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28
Transportation Information
*
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YES, my child will need bus transportation to and from camp. I am aware that I will be informed of the time/location that my child will be picked up and dropped off. (Each address must be located within my child' school district) Si, mi hijo necesitará transporte de autobús hacia y desde el campamento. Soy consciente de que seré informado de la hora/lugar en que mi hijo será recogido y dejado.
NO, I will provide my own transportation. I understand that students who are consistently late being picked up may be dismissed from the program. No, proporcionaré mi propio medio de transporte. Entiendo que los estudiantes que lleguen constantemente tarde pueden ser retirados del programa.
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29
Please list the pick-up and drop off location(s). If your child needs to be picked up and dropped off at different locations, please indicate this below! / En caso afirmativo, indique el lugar de recogida y entrega.
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30
Did your child go to preschool or daycare? / Su hijo fue al preescolar o al kindergarden?
*
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YES
NO
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31
Please list the daycare center, in-home daycare, or preschool program / En caso afirmativo, indique la guardería, la guardería en el hogar o el programa preescolar.
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32
How long did your child attend preschool or daycare? / En caso afirmativo, ¿cuánto tiempo asistió su hijo al preescolar o la guardería?
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33
Application Signature/Firma de la solicitud : I agree and understand the terms set forth in this application. I understand that my application is not final until I receive a confirmation upon receipt of this signed enrollment agreement. I also understand that the program may be cancelled if the enrollment minimum is not met. PLEASE TYPE YOUR NAME BELOW**/ Firma de la solicitud: acepto y entiendo los términos establecidos en esta aplicación. entiendo que mi solicitud no es definitiva hasta que reciba una confirmación al recibir esta inscripción firmada como aceptada. También entiendo que el programa puede ser cancelado si el mínimo de inscripción no es reunido.
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