2019 Summer Camp Registration
Please fill in a SEPARATE FORM for each camper you are enrolling.
Parent Info - First and Last Name *
Your answer
Address, City, State and Zip *
Your answer
Preferred Contact Phone Number *
Your answer
Alternate Phone Number *
Your answer
Email Address *
Your answer
Interested in Beforecare or Aftercare?
CAMPER INFORMATION
Camper's First and Last Name *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School *
Your answer
Grade Completed as of May 2019 *
Your answer
What language(s) are spoken at home? What language(s) does your child speak? *
Your answer
Move and Play Camps
For ages 3 - 4, entering Preschool and Pre-K in the fall. All Move & Play campers must be able to use the toilet independently. We ask that children who have never been in a full day program sign up for at least 3 consecutive weeks of camp.
Please select one or more camps. Camps cost $230 per week
Imagine That Camps
For ages 5-6, entering Kindergarten - 1st grade in the fall.
Please select one or more camps. Camps cost $230 per week.
Discovery Camps
For ages 7 - 9, entering 2nd - 4th grades in the fall.
Please select one or more camps. Camps cost $230 per week.
Exploration A Camps (also see Exploration B Camps below for alternate offerings)
For ages 10 - 15, entering 5th grade and up in the fall.
Please select one or more camps. Camps cost $230 per week. NOTE: Some camps have an additional activities fee
Exploration B Camps
For ages 10 - 15, entering 5th grade and up in the fall.
Please select one or more camps. These camps are $230 per week with an additional activities fee.
Other Required Information
THIS INFORMATION IS NEEDED SO STAFF IS PREPARED TO GIVE THE BEST POSSIBLE CARE TO YOUR CHILD.

Please provide a medical/behavioral plan as applicable.

Does your child have any medical or other needs that require special attention? (autism, Asperger’s, behavioral challenges, asthma, diabetes, seizures, severe allergies, medication, etc.) *
If yes, please describe.
Your answer
Has your child been assessed? *
PICK UP INFORMATION
The following individuals ONLY are authorized to pick up my child at SFSAS. I understand that if I wish any other persons (including other camp parents) to pick up my child I must personally hand a letter to the office requesting this change.
Name, Relationship to Child, Contact Number *
Your answer
Name, Relationship to Child, Contact Number *
Your answer
EMERGENCY CONTACTS
(Must be 2 individuals other than parents or step parents)
Name, Relationship to Child, Contact Number *
Your answer
Name, Relationship to Child, Contact Number *
Your answer
Medical Treatment Authorization
Submission of this form authorizes Santa Fe School for the Arts & Sciences to seek medical treatment and transportation for my child in case of a medical emergency. In the event of a medical emergency, 911 will be called and children will be transported to the nearest hospital, accompanied by a staff member.
Doctor's Name and Phone Number *
Your answer
Has your child had chicken pox. If yes, when? *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Santa Fe School for the Arts & Sciences. Report Abuse - Terms of Service