2019 Girls Summer Camp
Please note that this is a Google generated form. Hard copies forms are available upon request.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Preferred Name (Nickname)
Your answer
Date of Birth *
(mm/dd/yy)
Your answer
Gender *
Required
Current School *
Your answer
What week(s) will you attend? *
Required
Will you need After Care? *
Required
Will you need Before Care? *
Required
Please list the first and last name(s) of persons who are allowed to pick up your daughter. *
Write n/a if only Parent 1 & 2 are allowed to pick up your daughter.
Your answer
Name of Parent/Guardian #1 *
Your answer
Parent/Guardian #1 Phone *
What is the best number to reach you?
Your answer
Parent/Guardian #1 Email *
Your answer
Name of Parent/Guardian #2
Your answer
Name of Parent/Guardian #2 Phone
What is the best number to reach you?
Your answer
Parent/Guardian #2 Email
Your answer
How did you hear about Girls Summer Camp? *
Required
Emergency Contact Information
In case we are unable to reach you, please list emergency contacts for your daughter.
Emergency Contact (1) *
Your answer
Relation (1) *
Your answer
Phone (1) *
Your answer
Emergency Contact (2) *
Your answer
Relation (2) *
Your answer
Phone (2) *
Your answer
Emergency Contact (3)
Your answer
Relation (3)
Your answer
Phone (3)
Your answer
Physician Name *
Your answer
Physician Phone *
Your answer
Dentist Name *
Your answer
Dentist Phone *
Your answer
Please take my daughter to the following hospital *
Your answer
Include known allergies, medical issues, and medications. Write your daughter's name on every bottle of medication sent to camp. *
Write n/a if not applicable.
Your answer
Indemnification Waiver - Parent Signature *
I certify that the child named is in normal health and give permission for her to participate in program activities. I hold blameless Julia Moran School for Girls and Girls Summer Camp and all involved in the program from any liability for any harm that befalls the child as a result of participation in the programs. I authorize the employees of Girls Summer Camp to consent to medical care to be rendered to the child upon the advice of a licensed physician. The undersigned further agrees that the employees of Girls Summer Camp and the Julia Morgan School for Girls are not legally of financially liable for any claim arising out of consent given in good faith in connection with such diagnosis and treatment.
Your answer
Photo Release - Parent Signature *
I hereby grant Girls Summer Camp the right and permission, in connection with photos and video taken of my child, her artwork or written work, the following: the right to use the aforementioned items, without the use of names, for promotional/advertising purposes, e.g. the internet and camp fairs.
Your answer
Parent Signature *
Please write the first and last name of the person completing this form.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Julia Morgan School for Girls. Report Abuse - Terms of Service