EmailMe Form - Early Childhood Summer Camp 2017

Student's Name *
First Last
Date of Birth *
Sex
Male
Female
School Attending
Parent or Guardian Name *
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Home Phone *
### - ### - ####
Other Phone
### - ### - ####
Emergency Contact Name (Other than Parent listed above) *
First Last
Relationship
Emergency Contact Phone *
### - ### - ####
Please Note:
The undersigned hereby gives permission for the student named above to take part in all of The Children’s School activities, including sports, photographs for promotional purposes, trips away from the school premises, and absolves the school from liability for any injury incurred by the student at school or during a school activity. In the event of illness or accident to the student and the above people cannot be reached, school personnel is authorized to provide first aid, transport the student to any hospital and to authorize emergency medical or dental care by a duly licensed physician or dentist, and hospital care. The undersigned shall indemnify and hold harmless the school and any representative of it from and against any and all liability which may occur as a result of the exercise of the foregoing consent.
Signature of Parent or Guardian *
Clear
Allergies, injuries, operations, restrictions on physical activity, or anything else we should know about your child: *
List persons Authorized to pick up student.

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Please select the program (Kindergarten, Prekindergarten, or Preschool) and dates your child will attend camp from the options below.
Kindergarten Camp

3 Weeks (July 24 - Aug. 11) July 24 - 28 July 31 - August 4 August 7 - 11

Kindergarten ($350/wk, or $1000 for 3 weeks)
Prekindergarten Camp

July 24- 28 - CLOSED July 31 - August 4 - CLOSED August 7 - 11

Prekindergarten ($350/week)

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	3 Weeks (July 24 - Aug. 11)	July 24 - 28	July 31 - August 4	August 7 - 11
Kindergarten ($350/wk, or $1000 for 3 weeks)

	July 24- 28 - CLOSED	July 31 - August 4 - CLOSED	August 7 - 11
Prekindergarten ($350/week)

Preschool Camp

	3 Weeks (July 24 - Aug. 11)	July 24 - 28	July 31 - August 4	August 7 - 11
Preschool: M-F, Full Day ($350/wk, or $1000 for 3 weeks)
Preschool: M-F, Half Day ($295/wk or $845 for 3 weeks)
Preschool: MWF, Full Day ($255/wk or $730 for 3 weeks)
Preschool: MWF, Half Day ($235/wk or $670 for 3 weeks)

Please select the program (Kindergarten, Prekindergarten, or Preschool) and dates your child will attend camp from the options below.