Half-day Camp Registration Form

Address *

Phone Number *

Area Code Phone Number
E-mail *
Emergency Contact (Other than primary contact) *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
MEDICAL INFORMATION
Medical Concerns; Allergies; Special needs: (physical; developmental; behavioral/emotional; sensory). This information helps our staff to do their best to accommodate all of our students particular needs.
Authorization for Medical Treatment in the event that parents/guardians named on this form cannot be reached, I authorize officials of the Blue Giraffe Education Center to consent on my behalf, to provide emergency treatment for my child I Agree *

I Agree
Signature

Clear
*

May 28th Half Day Camp $ 60.00

How Many Half Days

Total $ 0.00

Half-day Camp Registration