Clone of Graham Camp Registration Form

HWY30 Camp Registration Form

Summer Session Three - July 20th to August 14th **must have completed Kindergarten+ for registration**
Parent's Name*

First NameLast Name
Parent's E-mail Address*
example@example.com
Parent's Cell Number*
Format: (000) 000-0000.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Child's Age*
Child's Highest Grade Completed*
Child's Allergies (please list or type none)*
My child is a competent swimmer and CAN SWIM without assistance (can enter/exit a pool safely on their own, can tread water or float on their back for 1 minute, can swim 25 yards with no assistance).My child is a non-swimmer and CAN NOT SWIM. Please place a properly fitted and fastened US Coast Guard approved life jacket on my child before entering any swimming pool and require it to be left on at all times while in or around a swimming pool.
Please list any siblings currently enrolled at PLC:
Child's Registration Date(s)*
I understand by signing my child up for camp, I will be charged by the week following my child's attendance. If my child does not attend a registered camp day, I am responsible for 50% of my child's daily camp fees. If I do not cancel my child's camp enrollment at least 5 days in advance, I am responsible for 50% of my child's daily camp fees. Prodigy Learning Center must have your family's ACH account on file in order for your child to remain registered.
Parent Signature*

Clear
Should be Empty:

HWY30 Camp Registration Form