Summer Camp Registration Form
Student Information
Name
First Name
Last Name
Grade
School Last Attended
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first
*
Emergency Information
Name
First Name
Last Name
Relationship
Phone Number
Please let us know if this child have any allergies
*
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Seattle Amistad School during the selected camp.
Agree
I do not agree
Media Disclosure Seattle Amistad School may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, Website, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children during Camp. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at our Summer Reading Camp. You can also follow us on Facebook to capture all of the pictures yourself!
Agree
I do not agree
Please read Amistad Policies and Procedures
Select the days your child will attend the camp.
Fee x each day $93
Monday
Tuesday
Wednesday
Thursday
Friday
Week 1, June 17- 21 (June 19 No camp/ Holiday)
Week 2, June 24- 28
Week3, July 1- 3
Summer Camp
*
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( X )
Summer camp x day
$
93.00
Quantity
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Credit Card
Date of Registration
*
-
Month
-
Day
Year
Date
Submit
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