Registration/Permission Slip

Kidz Kamp Registration
Child's Name*

First NameLast Name
Date

MonthDayYear
Date
Address

Street Address

Apt. No.

CityState / Province

Postal / Zip Code
Age Of Child
Birth Date

MonthDayYear
Date
Grade
School
PARENT/GUARDIAN NAME

First NameLast Name
Phone: Home
Please enter a valid phone number.
Phone: Cell
Please enter a valid phone number.
Please list any food allergies or other allergies. (As part of our program, KK serves weekly meals and snacks).
MEDICAL Does your child have any medical problems we should be aware of?

YesNo
If so, please list them here
Does Your Child Have?

ADDADHDDiabetesSeizuresOther
If You Said Other, Please List What Your Child Has Here
TO MINIMIZE BEHAVIORAL PROBLEMS CHILDREN WHO REQUIRE MEDICATIONS SHOULD TAKE THEM BEFORE ARRIVING AT KIDZ KAMP. (STAFF CANNOT GIVE MEDICATIONS).
EMERGENCY CONTACT

We must have an emergency contact number where we can reach YOU or someone desingnated by you (neighbor, relative, friend) in case there is an emergency during the time your child is in our care. THIS IS MANDATORY FOR ALL CHILDREN. If you do not give us an emergency contact, your child will not be allowed to attend.
Emergency Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
PICK UP AUTHORIZATION The following individual(s) are NOT allowed to pick up my child after club and escort him/her home.
PARENT/GUARDIAN SIGNATURE

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Basketball Camp Registration
Basketball Camp Will Meet on August 4-6th
FOOD Do you give us permission to give your child a free provided meal during your child's time with us?

YesNo
Child's Name*

First NameLast Name
Address

Street Address

Apt. No.

CityState / Province

Postal / Zip Code
Age Of Child*
Birth Date*

MonthDayYear
Date
Please list any food allergies or other allergies.
MEDICAL Does your child have any medical problems we should be aware of?

YesNo
If so, please list them here
Does Your Child Have?

ADDADHDDiabetesSeizuresOther
If You Said Other, Please List What Your Child Has Here
EMERGENCY CONTACT

We must have an emergency contact number where we can reach YOU or someone desingnated by you (neighbor, relative, friend) in case there is an emergency during the time your child is in our care. THIS IS MANDATORY FOR ALL CHILDREN. If you do not give us an emergency contact, your child will not be allowed to attend.
Emergency Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
PARENT/GUARDIAN SIGNATURE

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Should be Empty:

TO MINIMIZE BEHAVIORAL PROBLEMS CHILDREN WHO REQUIRE MEDICATIONS SHOULD TAKE THEM BEFORE ARRIVING AT KIDZ KAMP. (STAFF CANNOT GIVE MEDICATIONS).