Diamond In The RAW: So You Want To Be A Host Workshop? Emergency Contact Information

Parent/Guardian Name 

 *

Parent/Guardian Cell 

 *

Home Address 

 *

Does your child have any allergies or special needs? 

Grade child is entering in Fall of 2024

Emergency Contact #1 (Name, Phone Number, Relationship To Child) 

Emergency Contact #2 (Name, Phone Number, Relationship To Child)

Who is authorized to pick up your child from camp?

Please add 2 contacts (Name, Phone Number, Relationship to Child) 

Authorization for Medical Treatment (Yes/No)

I authorize an adult representative of Da Vinci Schools, when a parent or legal guardian cannot be located, to authorize and obtain medical treatment for my child in the event of an emergency. 

Pickup Authorization (Yes/No)

I understand that all campers must be picked up within 15 minutes of the camp ending. No one other than those listed on this form will be allowed to pick up my child from Da Vinci Summer Camp 2024. Any of these people might be asked for identification.


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