SUMMER CAMP (HAZLET) 2018 REGISTRATION FORM
Email address *
Camp Type *
Required
Child Information
First Name *
Your answer
Last Name : *
Your answer
Grade *
EARLY DROP OFF / LATE PICK UP *
Parent(s) / Guardian(s)
Allergies or Intolerance to food , etc. ( any additional information, which we need to be aware of) *
Your answer
Medications, Child takes *
Your answer
Father's Full Name: *
Your answer
Father's Cell Phone : *
Your answer
Father's Email : *
Your answer
Mother's Full Name *
Your answer
Mother's Cell Phone : *
Your answer
Mother's Email : *
Your answer
Parent's Home Address *
Your answer
How did you hear about this camp ? *
Your answer
Agreements :
* "The Scholar" Tree shall not release a child to any person without the parent's consent
* In the event of serious disciplinary problems, the program reserves the right to terminate a child through written
notice.
* I hereby authorize my child's photo to appear in the media or to be used to promote or publicize programs
* The Scholar Tree shall notify parents/guardians whenever their child becomes ill and the parent /guardian will arrange
to have the child pick up as soon as possible.
* In the event I can not be reached in emergency, I hereby give permission to "The Scholar Tree" to seek medical
treatment for my child at the nearest medical facility. I agree that I carry health insurance for my child and I am fully
responsible for medical expenses and all other relevant expenses incurred.
Parent / Guardian signature *
Your answer
Date : *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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