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
Date
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
Date
Photo/Media Release - Permission

Yes, I give permission for my child’s photo to be used for school-related materials.No, I do not give permission.
Signature (Photo/Media Release)
Office Use Only - Date Received

MonthDayYear
Date
Office Use Only - Enrollment Confirmed

YesNo
Office Use Only - Notes
Should be Empty: