Beit Fann Class Registration

Beit Fann Mid-term Camp

Registration Form
Child's Name*

First NameMiddle NameLast Name
Child's Age*
Child Birth date*

MonthDayYear
Which date/s are you interested to book? Please Note, the completion of this form Does Not mean your booking is confirmed. You will receive a confirmation email for your booking. *
Which date/s are you interested to book? Please Note, the completion of this form Does Not mean your booking is confirmed. You will receive a confirmation email for your booking.*

February 10February 11February 12February 13February 14
Parent's Name*

First NameLast Name
Parent's Contact Number*
Please enter a valid phone number.
E-mail Address*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT INFORMATION
Name*

First NameLast Name
Phone Number*
Are there any specific medical or health conditions that we should know about? incl. allergies and dietary requirements. *
Please provide any additional information that may affect your child's ability to fully partake in our program:*
I understand that this program will include activities at Beit Fann and around The Sustainable city community. In the event of illness, injury or accident, I authorize the program staff to act on my behalf and take the necessary step with the best interest of my child. In the event of an emergency, I understand that I will be notified as soon as possible.*

I AgreeI Disagree
I give permission to Beit Fann, and/or parties designated by Beit Fann to photograph/video my child and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.*

I AgreeI Disagree
By submitting this form I WAIVE, RELEASE AND DISCHARGE Beit Fann from any and all liability, including but not limited to, personal injury, property damage or loss.

Beit Fann Mid-term Camp

EMERGENCY CONTACT INFORMATION