Culinary Academy Registration Form - Spring 2026
These forms are required for your Student to attend.
A Free Culinary Course for High School Students!
Looking to see if cooking is for you or maybe learn the art of cooking to help out at home. This 2 day course is a fun interactive way to introduce you to the art of cooking. Note: Completing both days of the program will earn you a Diploma Plus asset though SDOW.
Topics Covered:
Personal Hygiene, Food Handlers Certification, Mise En Place, Clean- As-You- Go, Weights & Measurements, Knife Skills, Culinary Math, Kitchen Equipment, Recipes, Fabrication of proteins & vegetables, Menu Planning, + Prep & Serve.
Student's Information
Student Name
*
Nickname
Date of Birth
*
-
Month
-
Day
Year
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NOTE -
Students need to have completed 9th Grade before they are eligible to participate in camp.
Grade in 2025/26 School Year
*
Please Select
10th
11th
12th
School Camper Attends
*
Please Select
Washington High School
Borgia High School
Other
T-Shirt Size
Please Select
AS
AM
AL
AXL
AXXL
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Parents' Information
Parent/Guardian 1
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
example@example.com
Cell Phone
*
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Emergency Contacts/Authorized Pickup
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact
Emergency Contact #1
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Street
City
Postal / Zip Code
Primary Phone Number
*
Secondary Phone Number
*
Relationship to Child
*
Emergency Contact #2
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Street
City
Postal / Zip Code
Primary Phone Number
*
Secondary Phone Number
*
Relationship to Child
*
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Medical / Health Information
Name of Physician or Clinic/Hospital
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Is the student up-to-date on all immunizations?
*
Yes
No
Does your child have any food, medication or environmental allergies?
*
Yes
No
Allergies? Check all that apply
*
Food
Medication
Environmental
Please list and explain any allergies
*
0/150
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?
*
Yes
No
Does your child have a special health or medical condition?
*
Yes
No
Please explain
*
0/150
Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?
*
Yes
No
Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?
*
Yes
No
Please explain
*
0/150
If yes, does this medication, food supplement, or medical food need to be administered at the day camp?
*
Yes
No
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
*
Yes
No
Please explain
*
0/150
Does this dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group?
*
Yes
No
List any history of hospitalization, outpatient surgery, or previous health concerns that would be needed to assist the staff or medical personnel in an emergency situation.
*
0/200
List any additional information about your child that would be useful for staff to know, such as fears, eating habits, or special routines. This information should not be medical or health related, as that information should be included in the previous questions.
*
0/200
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