Prep Camp Registration 2019-2020
Please complete the form below to register for the Loomis Union School District TK/K Prep Camp.
The camp will take place July 29th - August 2nd 2019.

Completing this form by June 3rd will guarantee a space in the camp for your child. Please note that students must be enrolled in TK or Kindergarten at a Loomis District School District to participate in this Summer Prep Camp.

We will send more details in mid-June to all who have registered.

Student Information
Student First Name: *
Your answer
Student Last Name: *
Your answer
Student Date of Birth: *
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Mailing Address: *
Your answer
City: *
Your answer
State *
Your answer
Zip Code: *
Your answer
School of Attendance in 2019-20 Year: *
For the 2019-20 school year my child will be entering: *
Does you child currently have an IEP? *
What is your preferred location for Summer Prep Camp: *
We will make every effort to place you child at your preferred location, however there is no guarantee.
Parent/Guardian Information
Parent/Guardian First Name: *
Your answer
Parent/Guardian Last Name: *
Your answer
Parent/Guardian Phone Number: *
Your answer
Parent/Guardian Alternate Phone Number:
Your answer
Parent/Guardian E-mail Address: *
Your answer
Medical Information
Child's Physician: *
Your answer
Child's Physician Phone Number: *
Your answer
List of Child's Current Medications: *
Your answer
Child's Allergies: *
Please be specific
Your answer
Please check any of the following that might apply to your child: *
Required
Emergency Contact: *
Your answer
Emergency Contact Phone Number: *
Your answer
Emergency Contact Relation to Child: *
Your answer
What action is to be taken for your child if there is a complication due to an allergic reaction or health condition? *
Your answer
In case of accident/emergency, if parent or guardian cannot be reached, I authorize a representative of the school district to make such arrangements as he/she considers necessary for my child to receive medical or hospital care, including necessary transportation. I authorize such care and treatment to be performed by any licensed physician or surgeon by entering my initials below: *
Your answer
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