CAA Spring Break Camp Registration Form
Please fill out the fields below and select the week(s) that your child will be attending our Spring Break camp.
Child's Information
Child's Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Care Card Number
Does your child have any medical conditions including epilepsy, allergies, or asthma?
Does your child use an Epipen?
Does your child use an inhaler?
Does your child use any emergency medication?
Does your child have any special needs including ADHD, autism, or behavioral problems?
Parent or Guardian Information
Parent or Guardian 1's Name
First Name
Last Name
Relationship to Child
Phone Number
Please enter a valid phone number.
Email
example@example.com
Parent or Guardian 2's Name
First Name
Last Name
Relationship to Child
Phone Number
Please enter a valid phone number.
Emergency Contact (in the event of an emergency we will first call the parents or guardians listed above in order. If we are not able to contact both parents or guardians we will try the emergency contact below).
First Name
Last Name
Relationship to Child
Phone Number
Please enter a valid phone number.
Pick Up Information
Please list below the full name and phone number of anyone who IS AUTHORIZED to pick up your child.
Please list below the full name and phone number of anyone who is NOT AUTHORIZED to pick up your child.
Camp Selection
Please select the week(s) your child will attend camp. 8am-4pm
March 18 - 22 Safari Zoo Camp ages 5-11yr
March 25 - 28 Science Camp ages 5-11 yr
I understand that there is a 50% NON REFUNDABLE deposit due at registration to hold my child's spot. I understand that if I decide to withdraw registration before the camp start date and have paid the full amount, 50% of tuition will be refunded and 50% will not.
Submit
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