Summer Camp Registration Form Summer Camp Registration FormChild Information:Child's Full Name* First Name Last Name Date of Birth (mm/dd/yyyy)*Age*Gender*Home Address* Street Address City State / Province / Region ZIP / Postal Code Parent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone Number*Emergency Contact #1 Name*Emergency Contact #1 Phone Number*Emergency Contact #2 Name*Emergency Contact #2 Phone Number*Medical Information:Does your child have any allergies?*yesnoIf yes, please specify:*Does your child have any medical conditions we should be aware of?*yesnoIf yes, please specify:*Is your child currently taking any medication?*yesnoIf yes, please specify:*Summer Camp Details:Preferred Start Date*Preferred End Date*Preferred Schedule* Full Day (8:45 am - 3:30 pm) Half Day (Morning: 8:45 am - 11:45 am Half Day Afternoon: 12:45 pm - 3:30 pm) Morning Care: 6:30 am - 8:45 am After Care: 3:45 pm - 7:00 pm Acknowledgment of State Requirements and School Rules:* I acknowledge and agree that by enrolling my child in the summer camp program at Inclusive Montessori School, I am responsible for ensuring that my child meets all state requirements for enrollment, including but not limited to vaccination schedules and health screenings. I understand that failure to comply with these requirements may result in my child's inability to attend the program. Furthermore, I agree to abide by all school rules and regulations, including those regarding behavior, attendance, and payment policies. I understand that the school reserves the right to enforce these rules to maintain a safe and productive learning environment for all students. Parent/Guardian Signature*Date* Date Format: MM slash DD slash YYYY Additional Information:How did you hear about our summer camp program?*WebsiteSocial MediaWord of Mouth
