Sensory Summer Camp 2024
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Child's Name
*
First Name
Last Name
Child's Age
*
Child's Grade Level
*
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Is Child Potty Trained
*
Please Select
Yes
No
Emergency Contact
*
First Name
Last Name
Emergency Contact Relationship to Child
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Does your child have any allergies/special needs?
*
Yes
No
If Yes, Please describe any allergies/special needs below:
Consent and Agreement
I give permission to Your Kid's Table, LLC, and it's employees and volunteers, to provide treatment and services at the camp.
*
Please Select
Yes
No
In case of emergency, I understand that every effort will be made to reach the emergency contact listed on this form. If the emergency contact cannot be reached, I hereby give Your Kid's Table, LLC permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using necessary measures. I absolve Your Kid's Table, LLC from liability in acting on my behalf in this regard so long as Your Kid's Table, LLC is not grossly negligent. I further understand that all treatment costs (ambulance, emergency room fees, etc.) are my responsibility.
*
Please Select
Yes
No
Throughout the camp, we will be capturing photos and videos. I understand and allow the images to be used in print publications, online publications, websites, and social media applications. I understand that by selecting "No", Your Kid's Table, LLC will work to exclude my child from all photos and videos, but cannot guarantee it.
*
Please Select
Yes
No
Submit
Should be Empty: