Registration for Bhakti Immersion Winter Camp 2019
Venue:
ISKCON Naperville
1505 McDowell Road
Naperville, IL 60563

Ages: Camp is for children aged 5 - 12

Date and timings:
December 30, 2019 - January 3, 2020 (Monday through Friday), 10 AM to 5 PM everyday.

Lunch prasadam will be served, along with snacks during the day. Please indicate any food allergies in the form below.

Registration fee uptil December 20 is $100. After December 20, registration fee is $150.

2nd sibling get a 10% discount.

Registration is incomplete without payment.

You can pay by Zelle / Chase QuickPay at donate@iskconnaperville.org. You can also write a check payable to "ISKCON Naperville", or give cash to Premananda devi dasi (cell (630) 886-4619).

Before Care: Child care before 10 am costs $10 per hour per child.

PLEASE COMPLETE ONE FORM PER CHILD. SO IF YOU HAVE MULTIPLE CHILDREN, PLEASE COMPLETE MULTIPLE FORMS.
Child’s name *
Your answer
Child’s birth date *
For example, 01/27/2002 (mm/dd/yyyy)
MM
/
DD
/
YYYY
Home address *
Your answer
Mother’s/Father’s Name *
Your answer
Email *
Your answer
Cell Phone *
Your answer
Home/Alternate Phone *
Your answer
Work Phone
Your answer
Persons other than parents authorized to pick up your child. Provide names and their phone numbers. *
Your answer
Doctor's Name *
for Emergency Medical Care
Your answer
Doctor's Address *
for Emergency Medical Care
Your answer
Doctor's Phone number *
for Emergency Medical Care
Your answer
Does your child have special needs? *
If "Yes", please explain the nature of the special need (including allergies) and care needed.
Your answer
PARENT AUTHORIZATION
I agree that the staff or the institution offering this service is not liable for any unexpected accidents. In the event I cannot be reached, I hereby give the staff permission to administer first aid and/or obtain emergency medical care for my child. Any expense incurred will be accepted by me. I give permission for my child to be picked up by the authorized persons in case there is a need. I give permission for my child to be photographed on the campsite and understand that the photos may be used for publicity purposes.
Parent Authorization *
Submit
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