Request edit access
Bergen-Lafayette Montessori School Summer Camp Registration Form
Please complete the registration form found below.  Thank you!
Sign in to Google to save your progress. Learn more
Summer Camp 2025
Child's First Name *
Child's Last Name *
Gender: *
Date of Birth: *
MM
/
DD
/
YYYY
Child's Home Address *
Age on June 16, 2025 *
Other Schools Attended and Dates: *
PARENT #1 INFORMATION
First Name: *
Last Name: *
Cell Phone Number: *
Home Phone Number:
Email Address: *
PARENT #2 INFORMATION
First Name:
Last Name:
Cell Phone Number:
Home Phone Number:
Email Address:
Camp Enrollment (Please select at least two weeks of camp. Weeks do not need to be consecutive. Camp Hours 8:30 am - 3:30 pm - Breakfast, Lunch, and Snack Included - $585 Per Week) *
Required
Extended Day Enrollment (Extended Day Hours 3:30 pm - 5:30 pm; Snack Included $140 Per Week)
Does your child have any health issues? If so, please explain.  *
Does your child take any medications on a regular basis? If so, please explain.  *
Does your child have any allergies or dietary restrictions? If so, please explain.  *
Is there anyone other than the parent(s) listed on this registration form that may pick up your child? (BLMS does not release children to persons under the age of 16 years old).  *
Does your child have permission to take short walking trips with our summer camp staff?  *
Please advise us of your media release preferences.  *
Acting on behalf of yourself and your child, you hereby waive and agree to release any claims which you, your child, or your child’s heirs and successors may have against the school and its officers, directors, employees, or agents for any and all injuries, losses or damages to your child, your child’s personal property and your personal property. By signing this agreement, you specifically limit the school’s liability to the amount covered by the school’s insurance policies. *
I understand that I must register my child for a minimum of two weeks of summer camp (do not need to be consecutive) and that once I register for camp I am financially obligated to pay the camp fees. 
 *
I understand that registration and camp fees paid are non-refundable, should I decide to withdraw my child from camp prior to completing the summer camp program.  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bergen-Lafayette Montessori School.

Does this form look suspicious? Report

Google Forms