Kaleidoscope Kids Summer Camps

Child's First Name*

Child's Last Name*

Child's Date of Birth*

MonthDayYear

Child's Address*

Family Email*

Father/Mother/Guardian to contact*

Main Phone # *

Alternate Phone #

Emergency Contact (Not a parent)*

Main Phone #*

Alternate Phone #

MEDICAL INFORMATION: Please supply all important medical information below. If your child does not have allergies, food restrictions, health considerations or is not taking medication, please indicate with a N/A

Allergies/Retrictions*

Health Concerns*

Medications *

MEDICAL PERMISSION: I hereby give permission for my child to be transported by vehicle to the hospital in case of injury and/or to be transported in an ambulance in the case of an emergency to the nearest hospital.

I authorize all medical and surgical treatement, x-ray, labratory, anaesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the even that neither parent/guardian can be reached in the case of an emergency.

I have read, understand and agree to the above Medical Permission*

July 7-11 - Little Artists - NOLANJuly 28-Aug 1 - Wizards & Witches -TUSCANY

EVENT FEE AGREEMENT

I/We authorize Kaleidoscope Kids Preschool Inc. to debit: $175 for each camp selected except Little Artists which is $150. Payment is due upon registration. Cancellation policy: We will accept cancellations with a full refund if cancelled before June 1, 2025. Cancellations after this date are non-refundable.

We only accept automatic debit for payments. Please fill out the PAD agreement below if one has not already been set up. Debit payments shall be processed through Rotessa. REGISTRATION IS NOT COMPLETE UNTIL PAYMENT IS RECEIVED

Payment - Pre-Authorized Debit*

I acknowlege that I have read, understand and agree to all terms and conditions*

Enter the word as shown*

KALEIDOSCOPE KIDS SUMMER CAMP 2025