Broadmoor United Methodist Holiday Camp 2023/2024 Registration Form
Child's Information
Each Child Must Be Registered Separately
Child's Name
*
First Name
Last Name
What Grade is your child currently enrolled?
*
Prek-4
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Date of Birth
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Known Allergies or Medical Conditions and Current Medications
*
Indicate below the weeks for which you are registering
*
April 2
April 3
April 4
April 5
Parent Information
Parent/Guardians Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardians Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pick Up List- Please indicate names and phone numbers of any other people you will allow to pick up your child.
*
Permissions and Agreements
Cost is $45 per day.
I agree to pay tuition as stated above.
*
Agree
Disagree
We are an electronic free camp for all campers. Campers are not allowed to bring ipods/mp3 players, phones, electronic games, etc. to camp. If the device is brought to camp, it will be placed in the office until picked up by a parent. Broadmoor is not responsible for any toy/ device that is lost, stolen, or broken.
*
Agree
WE ARE A NUT FREE FACILITY. Parents will provide a NUT FREE lunch every day with a drink. No “hard coolers” please. We will provide a morning and afternoon snack. Water will be available to thechildren throughout the day.
*
Agree
I give Broadmoor United Methodist Summer Day Camp permission to use my child’s photographs for any sponsored advertising including but not limited to the website, Facebook, Instagram, and in print free of charge.
*
Agree
Disagree
Emergency: I permit Broadmoor United Methodist Summer Day Camp to secure medical treatment for my child.
*
Agree
Please sign indicating you agree to all statements above.
Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
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