EmailMeForm
No School Day - New Haven
Immanuel Missionary Baptist Church,
1324 Chapel Street, New Haven 06511
PARENTS INFORMATION
Mothers or Fathers Name
*
Cell Phone Number #1
*
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Cell Phone Number #2
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Email #1
*
DAY CAMP INFORMATION
No School: Full Day Camp or Half Day Camp
Please select
No School Day FULL DAY CAMP
No School Day HALF DAY CAMP
How many Children will you be registering for Our FULL Day CAMP?
Just one (1) Child for Full Day
Registering my two (2) Children for Full Day
Registering my three (3) Children for Full Day
How many Children will you be registering for Our HALF Day CAMP?
Just one (1) Child for Half Day
Registering my two (2) Children for Half Day
Registering my three (3) Children for Half Day
What DATE will you be registering for?
example: Wednesday September 16th
CHILD #1 INFORMATION
#1: Childs Full Name
*
Date of Birth
*
School Name
*
Grade
*
CHILD #2 INFORMATION
#2: Childs Full Name
Date of Birth
School Name
Grade
CHILD #3 INFORMATION
#3: Child's Full Name
Date of Birth
School Name
Grade
Food Allergies
Medical Concerns
INSURANCE INFORMATION
Do you need ALM Sports Insurance?
ALM Insurance cost $6 (per day)
*
Yes, ALM Sports Insurance
No
This fee covers up to 3 children
Primary Insurance Details
(your childs insurance carrier and policy number)
REFERRALS
Who Referred you?
How did you hear about this Camp?
TERMS & CONDITIONS
I have read and agree to the Terms of Service
*
Yes, I agree.
If your child is covered by a private insurance, you must provide us with proof of your child’s insurance coverage. If your child is not We offer this through WestPoint Insurers at a cost of $6.00 per day per sport. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow ALM Sports to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email admin@almsports.com. I confirm that my personal insurance is correct and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.
Total
$2.10
