Summer Camp at Blue Giraffe Art Studio
4545 42nd Street NW, Washington DC 20016
CHILD INFORMATION:
Child Name
*
First Name
Last Name
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
ADITIONAL INFORMATION
Please provide any information that can help our staff to do their best to accommodate all of our students particular needs.(Allergies, special needs: physical; developmental; behavioral/emotional; sensory).
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
Please indicate the dates if you are choosing camp by days
*
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Regular Week 9:00am - 1:00 pm 2
$
390.00
How Many Weeks
Second Child 10% off
$
351.00
How many weeks
Camp By Days
$
96.00
Please
Quantity
Camp By Days Second Child 2
$
86.00
Quantity
Total
$
0.00
Payment Methods
Credit Card
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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