SUMMER CAMP SIGN UP
Travel the World with Hollywood Schoolhouse and Summer Daze 2019 Summer Camp!
SummerDaze@hshla.org / 818-900-3319
June 17 -- August 9 at Hollywood Schoolhouse
STUDENT'S NAME
Your answer
DOB and AGE
Your answer
T-SHIRT SIZE
FULL ADDRESS [STREET, CITY, ZIP]
Your answer
CURRENTLY ATTENDING SCHOOL AT:
Your answer
PARENT'S NAMES
Your answer
PARENT'S EMAILS
Your answer
PARENT'S PHONE NUMBERS
Your answer
CHILD LIVES WITH:
IN CASE OF EMERGENCY, WHOM DO YOU WISH US TO NOTIFY IF NEITHER PARENT CAN BE REACHED? [NAMES, RELATIONSHIP AND PHONE NUMBERS]
Your answer
WHO DO YOU AUTHORIZE TO PICK UP CHILD FROM CAMP? [NAMES, RELATIONSHIP AND PHONE NUMBERS]
Your answer
DOES YOUR CHILD HAVE ALLERGIES? [FOOD, MEDICATIONS, ETC.]
IF YES, PLEASE EXPLAIN.
Your answer
DOES YOUR CHILD HAVE ANY PHYSICAL LIMITATIONS WE SHOULD KNOW ABOUT?
IF YES, PLEASE EXPLAIN.
Your answer
IS YOUR CHILD WATER SAFE AND ABLE TO SWIM ON THEIR OWN WITHOUT ASSISTANCE?
PHOTOGRAPH PERMISSION: I GIVE SUMMER DAZE CAMP PERMISSION TO PHOTOGRAPH, FILM OR RECORD MY CHILD FOR PURPOSES OF PROMOTING THEIR PROGRAM.
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