Summer Camp Registration Form

Summer Camp Registration Form

Register your child for Nordic Montessori School Summer Camp. Please complete all required fields and provide accurate information.
Child’s Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Parent/Guardian Name(s)
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City/State/Zip
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact 1 - Name
Emergency Contact 1 - Relationship
Emergency Contact 1 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 - Name
Emergency Contact 2 - Relationship
Emergency Contact 2 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies (food, environmental, medication)
Medical Conditions or Special Needs
Medications (if any)
Physician Name & Phone Number
Additional Information about Child (behavioral needs, preferences, fears, routines, etc.)
Parent/Guardian Signature (Medical Authorization)
Date (Medical Authorization)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photo/Media Release - Permission
Signature (Photo/Media Release)
Office Use Only - Date Received

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Office Use Only - Enrollment Confirmed
Office Use Only - Notes
Should be Empty: