Maywood Summer Club 2025
Welcome to the Maywood Summer Club 2025 form. Please complete the form in its entirety as the form will not save your progress if you leave and come back.
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Parent/Guardian Profile
Father's name (if applicable)
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Mother's name (if applicable)
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Mailing Address (street, city, state, zip)
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Parent/guardian email address
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Parent/guardian phone number
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Note: This number will be the primary phone number for emergencies
Secondary Parent/guardian phone number
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Child Profile
Child's Full Name
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What grade will your child be entering in the fall of 2025?
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Please Select
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Please upload a picture of your child
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Number of weeks your child will be attending
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Week 5: July 21 - July 25
Week 6: July 28 - Aug 1
Week 7: Aug 4 - Aug 8
Week 8: Aug 11 - Aug 15
Select the weeks your child will need aftercare?
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Not Applicabile
Week 5: July 21 - July 25
Week 6: July 28 - Aug 1
Week 7: Aug 4 - Aug 8
Week 8: Aug 11 - Aug 15
Do you consent to your child walking (weather permitting) or using the Borough of Maywood School Buses on trip day as necessary?
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Yes
No
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Emergency Contact Form
Please list the primary emergency contact that could pick up your child if needed (name, home phone, cell phone)
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Please list the secondary emergency contact that could pick up your child if needed (name, home phone, cell phone)
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Medical Information Release Form
Physician name
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Physician Telephone Number
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Health insurance company
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Policy ID Number
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Please list any food allergies your child has (Enter NA if the child does not have a food allergies)
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Please list any medical problems, conditions, disabilities, and/or medications your child is taking (Enter NA if the child does not have a medical condition)
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Will an Epi Pen or an inhaler be left at camp?
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Yes
No
Do you authorize the Maywood Recreation Department to use their best judgment for emergency treatment and / or in sending my child to the hospital for advanced medical treatment, if a parent/guardian cannot be reached.
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Yes
No
Please enter your full name as a digital signature acknowledging all this information is correct and was entered by a parent or guardian
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Please enter the date
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Month
-
Day
Year
Date
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Child Pick Up
Please enter the name, relationship, and phone number of your child's primary pick up person
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Please enter the name, relationship, and phone number of your child's secondary pick up person
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Please enter the name, relationship, and phone number of a third pick up person
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Additional Information
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