Summer Camp Registration Form
Please fill out this form to register for the summer camp. Filling out this form does not complete the registration process; you must contact the school to provide payment information.
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
SCHEDULE
*
7:30am to 2:00pm (Part Time)
7:30am to 6:00pm (Full Time)
Parent/Guardian Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Any Allergies or Medical Conditions?
Preferred Camp Session
*
Week 1: June 29 - July 03: Under The Sea Adventure
Week 2: July 06 - July 10: Little Scientist
Week 3: July 13 - July 17: Circus Fun
Week 4: July 20 - July 24: Little Chef
Week 5: July 27 - July 31: Mini Stars Talent Show
Enrollment Agreement
*
I hereby enroll my child for Summer Camp at IQ Village. Above child is in good physical and mental health. I realize that the activities involved in his or her education involve physical contact and hereby relinquish all rights to claim or recover damages for personal injuries in connection with his or her education at IQ Village Pre-School. I understand that the fee will be charged the Wednesday prior to the week my child will attend. I am responsible for providing food and snacks, and it is my sole responsibility to contact the school if my child will not attend for the day. Filling out this form does not complete the registration process; you must contact the school to provide payment information.
Submit
Should be Empty: