Classroom Matters Summer Camp Registration 2018
Child's First & Last Name *
Your answer
Child's Pronouns *
Birthdate *
MM
/
DD
/
YYYY
School *
Your answer
Grade Level as of Fall 2018 *
Parent/Guardian #1: Name *
Your answer
Parent/Guardian #1: Phone # *
Your answer
Parent/Guardian #1: Email Address *
Your answer
Parent/Guardian #2: Name *
Your answer
Parent/Guardian #2: Phone # *
Your answer
Parent/Guardian #2: Email Address *
Your answer
Emergency Contact #1: Name & Phone # *
Your answer
Emergency Contact #2: Name & Phone # *
Your answer
Allergies/Medical Conditions *
Your answer
Who is approved for pickup? *
Your answer
Does your child have any special needs or learning differences? If so, please elaborate. *
Your answer
Which week(s) will your child be attending camp? *
Required
Weekly Schedule (in order to keep a space in the program, you must commit to paying the $350/week fee ($300 for early bird pricing), even if your student does not attend all 5 days) *
Required
Is there anything else you'd like us to know about your child? *
Your answer
Payment *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms