WRTS Kids Gym Novi Summer Camp Pre-Registration

WRTS Kids Gym Novi Summer Camp Pre-Registration
Child Information
Child 1 Name*

First NameLast Name
Child 1 Gender*

MaleFemale
Child 1 Birth Date*

MonthDayYear
Child 1 Current School*
Child 2 Name

First NameLast Name
Child 2 Gender

MaleFemale
Child 2 Birth Date

MonthDayYear
Child 2 Current School
Which weeks are you interested in enrolling your child(ren)?*

June 8-12June 15-19June 22-26June 29-July 3July 6-10July 13-17July 20-24July 27-31August 3-7August 10-14August 17-21August 24-28
Which hours are you interested in?*

8am9am10am11am12pm1pm2pm3pm4pm
How did you hear about us? Who referred you?*
Parent/Emergency Contact Information
Name*

First NameLast Name
Relationship*
Cell Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your child verbal?*
Is your child potty trained?*
Does the child have any medical conditions and special requests? If yes, please describe.*
Does your child currently have an IEP?*

YesNo
Does your child currently have a BIP?*

YesNo
Should be Empty:

Child Information