Summer Camp Registration

Summer 2023 Camp Registration

9:00 am - 12:45 pm June 22-30, July 3-7, July 10-14, August 14-18, August 21-25, August 28 A minimum of 5 kids must sign up for the camp to take place
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Emergency Contact (Other than primary contact) *

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
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
9 pm - 12:45 pm; $475

One week$475.00

How Many Weeks
Item subtotal:$0.00

Second child 10% off$427.50

Quantity

One day August 28$95.00

August 28 second child 10% off$85.50

Total $0.00

Credit Card

Google Pay

Summer 2023 Camp Registration