Sprouts Summer Camp
Ages 4-6
July 6-8 (Wednesday-Friday) from 10am-1pm
Location: Sprouts Academy 801 NE 194th St. Ridgefield WA 98642
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Student name: *
Student date of birth *
Home Address *
Parent 1 name *
Parent 1 cell phone number *
Parent 2 name *
Parent 2 cell phone number *
Primary Email: *
Best Person to receive texts and phone calls? *
Emergency contact name (other than parents) *
Emergency contact relationship to child *
Emergency contact phone number *
Allergies or medical conditions (Please ask teachers if you need a medical form for permission to administer medication) *
Is there anyone other than the parents listed that is allowed to pick up your child? Please list names as they appear on identification or write NO *
Is it okay for Sprouts Academy to use your child's photograph for promotional purposes online and/or in printed format? *
Would you like your information to be accessible to other parents from Sprouts Academy for birthday invitations or scheduling playdates? *
By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge: *
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