City Seedlings Registration- Winter Camp 2017
City Seedlings application 2017
Email address *
Please enroll my child in: *
Required
I am interested in learning more about extended day options.
CAMPER INFORMATION
Child's Name: *
Your answer
Child's Birth Date: *
MM
/
DD
/
YYYY
Age: *
Your answer
Gender *
GUARDIAN INFORMATION
Name of Parent/Guardian #1: *
Your answer
Home Phone: *
Your answer
Cell Phone: *
Your answer
Daytime Phone: *
Your answer
Email: *
Your answer
Home Address: City, State, Zip *
Your answer
Name of Parent/Guardian #2
Your answer
Home Phone:
Your answer
Daytime Phone:
Your answer
Cell Phone:
Your answer
Email:
Your answer
Emergency Contact Information
Emergency Contact Name: *
Your answer
Emergency Contact's Relationship to Camper: *
Your answer
Emergency Contact Phone: *
Your answer
Emergency Contact Email: *
Your answer
CHILD HEALTH INFORMATION
1. Does your child have any physical or emotional conditions requiring special attention in a camp setting? *
If so please explain:
Your answer
2. Does your child have a history of loss of consciousness, convulsions, epilepsy, or diabetes? *
Your answer
3. Does your child have any allergies (e.g. bees, food, drug, or environmental)? *
if so: is there any corresponding medication we should be aware of?
Your answer
4. Is there any additional health information of which we should be aware?
For example: any medication your child is currently taking in case of an emergency.
Your answer
Do you give consent for medical treatment in an emergency if we can not reach you? *
Date of last Tetanus shot (month and year): *
Your answer
Insurance Company Name: *
Your answer
Insurance Company Phone: *
Your answer
Where did you hear about City Seedlings Summer Camp?
Where does your child go to school? *
Your answer
PLEASE TAKE NOTE OF THE FOLLOWING INFORMATION
You will receive a follow up email containing this information for your records, once your application has been processed.
Registration Policy
To register for City Seedling Summer Camp a completed registration application and payment in full must be submitted 48 hours prior to camp start date. Applications are processed on a first come first serve basis.
Refund/ Cancellation Policy
If weather is deemed unsuitable for outdoor activities a portion of the days cost will be refunded. Cancellations less than 7 days before the start date of camp will NOT be refunded.
Refreshments/ Food
A snack and vegetarian lunch prepared by the campers will be provided daily. We feel that trying new (healthy) foods is a vital part of the City Seedlings Camp experience, and we will encourage the kids to try what they've made.
Publicity Release
I give my permission for any quotes, images or likenesses of me or my child / and or artwork to be used for Garden School Foundation's publicity purposes including but not limited to newsletters, brochures, websites, videos, and other social media outlets.
Camp Groups
I understand that Garden School Foundation will do their best to accommodate group requests, however, I understand that the dynamics of the group may require they move students around to benefit the camp experience.
Parent Signature: *
Your answer
Date: *
Your answer
Your submission of registration application and payment indicates that you have read and agreed to all the policies and information contained herein.
PAYMENT
If you need to submit payment, please go to:
http://gardenschoolfoundation.org/summer-camp/
A copy of your responses will be emailed to the address you provided.
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