EmailMeForm
Spring Break Camp 2024- Margate
Cokesbury Church
PARENTS INFORMATION
Mothers Name
*
Fathers Name
*
Cell Phone Number #1
*
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Cell Phone Number #2
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Email #1
*
Email #2
How Many Children are you Registering?
*
Only One Child
Two Children
Three Children
CHILD #1 INFORMATION
#1: Child's Full Name
*
Date of Birth
*
School Name
Grade
*
1st child: Which day will your child be attending:
*
1st child: All 5 Days ($120)
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1st child: Mon Mar 25th ($30)
1st child: Tue Mar 26th ($30)
1st child: Wed Mar 27th ($30)
1st child: Thur Mar 28th ($30)
1st Child: Fri Mar 29th ($30)
CHILD #2 INFORMATION
#2: Child's Full Name
#2: Date of Birth
#2: School Name
#2: Grade
#2nd child: Which day will your child be attending:
2nd child: All 5 Days ($110)
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2nd child: Mon Mar 25th ($30)
2nd child: Tue Mar 26th ($30)
2nd child: Wed Mar 27th ($30)
2nd child: Thur Mar 28th ($30)
2nd child: Fri Mar 29th ($30)
CHILD #3 INFORMATION
#3: Child's Full Name
#3: Date of Birth
#3: School Name
#3: Grade
#3rd child: Which day will your child be attending:
3rd child: All 5 Days ($110)
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3rd child: Mon Mar 25th ($30)
3rd child: Tue Mar 26th ($30)
3rd child: Wed Mar 27th ($30)
3rd child: Thur Mar 28th ($30)
3rd child: Fri Mar 29th ($30)
INSURANCE
Do you need ALM Sports Insurance?
ALM Insurance cost $10
*
Yes, ALM Sports Insurance
No
Will cover up to 5 days
Do you need Insurance for your Second Child?
Yes, second child insurance
No
Do you need Insurance for your Third Child?
Yes, Third child insurance
No
Primary Insurance Details
(your childs insurance carrier and policy number)
Medical Concerns
Food Allergies
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 $10.00 for up to 5 days during the Spring break camp. 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
$2.25
