Welcome to Fall Day Camps 2019!
Please register one camper at a time. You will be able to return to the beginning of the registration form once you click SUBMIT.
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name *
Your answer
Email *
Your answer
Phone *
Your answer
Emergency Contact Information
In case of emergency and a parent/guardian is not available, list two (2) emergency contacts.
Emergency Contact 1 *
Your answer
Emergency Contact Phone *
Your answer
Relationship *
Your answer
Pick-up Authorization
At the conclusion of the program day, I authorize the following people to pick up my child. List any individual including yourself (must be 16 or older).

If you would like to provide more than 3 names, please send an email to info@kid-museum.org with the additional contact information.
Person authorized to pick-up your child *
Your answer
Person authorized to pick-up your child
Your answer
Person authorized to pick-up your child
Your answer
I understand that my child will only be released to the individuals listed above. They will be expected to sign my child out each day and will be required to show a PHOTO ID. *
Required
Camper Information
Please put information for ONE child only. Thank you!
First Name *
Your answer
Last Name *
Your answer
Birthdate
MM
/
DD
/
YYYY
Grade *
Camps Attending *
Please select all that apply.
Required
Health Information
KID Museum is committed to complying with the Americans with Disabilities Act (ADA) and promoting inclusion in our program. All information captured here will remain confidential.
Please list any medical conditions that our staff needs to be aware of (i.e. peanut allergies, asthma). *
Your answer
Our educators hope to provide your children with the best learning experience possible. Does your child have special needs or require special assistance or accommodation? *
Next
Never submit passwords through Google Forms.
This form was created inside of KID Museum. Report Abuse - Terms of Service