How many students are you registering
*
Please Select
1
2
3
4
5
Student's Name
First Name
Last Name
Gender
*
Please Select
Male
Female
Student's Date of Birth
*
/
Month
/
Day
Year
Date
Grade they will enter this fall (i.e. 1st, 2nd, etc.)
*
What size shirt will your child need?
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Swim Test
I give permission for my child to take a swimming test at the public pool in order to gain access to access to deeper areas.
I DO NOT give permission for my child to take a swimming test at the public pool in order to gain access to deeper areas.
Allergies (indicate food, medication, animal, and/or seasonal)
*
Yes
No
Reactions and responses to allergies (Include visual indicators for a reaction as well as instructions in the case of an allergic reaction)
Will your student take medication daily during Summer Enrichment?
*
Yes
No
What type of medication and time will it need to be taken?
Any Medical Conditions we need to be aware of? (indicate operations, injuries, etc.)
*
(2) Student's Name
*
Gender
*
Please Select
Male
Female
Student's Date of Birth
/
Month
/
Day
Year
Date
Fall Grade (i.e. 1st, 2nd, etc.)
*
What size shirt will your student need?
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Swim Test
*
I give permission for my child to take a swimming test at the public pool in order to gain access to access to deeper areas.
I DO NOT give permission for my child to take a swimming test at the public pool in order to gain access to deeper areas.
Allergies (indicate food, medication, animal, and/or seasonal)
*
Yes
No
Reactions and response to allergies (include visual indicators for a reaction as well as instructions in the case of an allergic reaction)
Will your student take medication daily during Summer Enrichment?
*
Yes
No
What type of medication and time will it need to be taken?
Any Medical Conditions we need to be aware of? (indicate operations, injuries, etc.)
*
(3) Student's Name
*
Gender
*
Please Select
Male
Female
Student's Date of Birth
*
/
Month
/
Day
Year
Date
Fall Grade (i.e. 1st, 2nd, etc.)
*
What size shirt will your child need?
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Swim Test
*
I give permission for my child to take a swimming test at the public pool in order to gain access to access to deeper areas.
I DO NOT give permission for my child to take a swimming test at the public pool in order to gain access to deeper areas.
Allergies (indicate food, medication, animal, and/or seasonal)
*
Yes
No
Reactions and response to allergies (include visual indicators for a reaction as well as instructions in the case of an allergic reaction)
Will your student take medication daily during Summer Enrichment
*
Yes
No
What type of medication and time will it need to be taken?
Any Medical Conditions we need to be aware of? (indicate operations, injuries, etc.)
*
(4) Student's Name
*
Gender
*
Please Select
Male
Female
Student's Date of Birth
*
/
Month
/
Day
Year
Date
Fall Grade (i.e. 1st, 2nd, etc.)
*
What size shirt will your child need?
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Swim Test
*
I give permission for my child to take a swimming test at the public pool in order to gain access to access to deeper areas.
I DO NOT give permission for my child to take a swimming test at the public pool in order to gain access to deeper areas.
Allergies (indicate food, medication, animal, and/or seasonal)
*
Yes
No
Reactions and response to allergies (include visual indicators for a reaction as well as instructions in the case of an allergic reaction)
Will your student take medication daily during Summer Enrichment?
*
Yes
No
What type of medication and time will it need to be taken?
Any Medical Conditions we need to be aware of? (indicate operations, injuries, etc.)
(5) Student's Name
*
Gender
*
Please Select
Male
Female
Student's Date of Birth
*
/
Month
/
Day
Year
Date
Fall Grade (i.e. 1st, 2nd, etc.)
*
What size shirt will your child need?
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Swim Test
*
I give permission for my child to take a swimming test at the public pool in order to gain access to access to deeper areas.
I DO NOT give permission for my child to take a swimming test at the public pool in order to gain access to deeper areas.
Allergies (indicate food, medication, animal, and/or seasonal)
*
Yes
No
Reactions and response to allergies (include visual indicators for a reaction as well as instructions in the case of an allergic reaction)
Will your student take medication daily during Summer Enrichment?
*
Yes
No
What type of medication and time will it need to be taken?
Any Medical Conditions we need to be aware of? (indicate operations, injuries, etc.)
*
Parent/Guardian Information
Parent/Guardian's Name
*
Select your relationship to the student(s)
*
Father
Mother
Guardian
Other
Primary Phone Number
*
Secondary Phone Number
E-mail
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Place of Employment
*
Is the Primary Emergency Contact different than the parent/guardian listed above?
*
Please Select
Yes
No
Emergency Contact Information
Name
*
First Name
Last Name
Select your relationship to the student(s)
*
Father
Mother
Guardian
Other
Phone Number
*
E-mail
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list any other individuals who you give permission to remove from our facility
*
Consent of Liability and Permissions
I agree to accept full responsibility for all obligations that may result from an injury incurred by my student(s) as a result of participation in any school-sponsored activity. In case of a medical emergency, I understand that every effort will be made to contact parents or guardians of campers. In the event I cannot be reached, I hereby give authority to any hospital or doctor to render immediate aid as might be required at the time for my child’s health and safety. I give permission for my child to take part in all camp activities, including sporting activities and bus trips away from the premises. I give permission for the Tri-City Summer Enrichment staff to chaperone my child(ren) to Chuparosa Park in Chandler, AZ.
Full Name
prev
next
( X )
Registration Fee
$
45.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Expiration Year
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Preview Registration
Print Registration
Submit Registraton
Should be Empty: