Beit Fann's Spring Camp Registration Form
Child's Name
*
First Name
Last Name
Child's Age
*
Parent's Name
*
First Name
Last Name
Parent's Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail Address
*
example@example.com
Home Address
*
Street Address
Street Address
City
Which date/s are you interested to book? Please Note, the completion of this form Does Not mean your booking is confirmed. You will receive a confirmation email for your booking.
*
March 24
March 25
March 26
March 27
March 28
April 2
April 3
April 4
EMERGENCY CONTACT INFORMATION
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Are there any specific medical or health conditions that we should know about? incl. allergies and dietary requirements.
*
Please provide any additional information that may affect your child's ability to fully partake in our program:
*
I give permission to Beit Fann, and/or parties designated by Beit Fann to photograph/video my child and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.
*
I Agree
I Disagree
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: