Summer Camp at Blue Giraffe Art Studio
4545 42nd Street NW, Washington DC 20016 June 14-18, 21-25, 28 - 7/2, July 5-9, 12-16, August 9-13, 16-20, 23-27, August 30-September 3. From 9:00 am to 1:00 pm $325; Extended day 9:00 - 3:30 pm $525 (or 1:00-3:30pm $200). Minimum of 4 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
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
*
example@example.com
Emergency Contact #1 (Other than primary contact)
*
First Name
Last Name
Emergency Contact #1 Phone Number
*
-
Area Code
Phone Number
Emergency Contact #2 (Other than primary contact)
*
First Name
Last Name
Emergency Contact #2 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
Signature
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Week #2
Week #3
Week #4
Week #5
Week #6
Week #6 Extended Day
Week #7
Week #7 Extended Day
Week #8
Week #8 Extended Day
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Regular Week 9:00am - 1:00 pm
$
325.00
How Many Weeks
Second Child 10% off
$
292.50
How Many Sessions
Extended Day Week 1:00 - 3:30 pm
$
200.00
How Many Weeks
Extended Day Second Child
$
180.00
How Many Weeks
I have credits
$
Free
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Signature
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