Camp Days Registration Form

Camp Days Registration

January 18, 19, 20, 29. From 9:30 am to 12:00 pm, $60. Minimum of 3 kids must register for this program to take place.
CHILD INFORMATION:
Child Name *

First Name Last Name
Grade *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
In good health?

Yes No
Fully vaccinated?

Yes No
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
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

Half Day Camp $ 60.00

How Many Sessions
Item subtotal: $ 0.00

Second Child / Second Session 10% off $ 54.00

How Many Sessions

I have credits Free

Total $ 0.00

Camp Days Registration