Classic Summer Camp Registration

First Camper's Name

First Name

Last Name

First Camper's Age and Birthdate

(Year) Month/Day/Year (exp. 03/06/2018)

Is your child potty independent?

for preschool families

Siblings' Name

First Name

Last Name

Siblings' Age and Birthdate

(Year) Month/Day/Year (exp. 03/06/2018)

Is your child potty independent?

For preschool families

Siblings' Name

First Name

Last Name

Siblings' Age and Birthdate

Month/Day/Year (exp. 03/06/2018)

Is your child potty independent?

Preschool families

Parent Name(s)

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Family or friends who may pick up your child

Please write their full name

First Name

Last Name

Family or friends who may pick up your child

Please write their full name

First Name

Last Name

Family or friends who may pick up your child

Please write their full name

First Name

Last Name

How did you hear about us?

Some of our programs involve food and cooking. Are there any food allergies or dietary restrictions we should know about?

Does your child have any health condition or medication that the school should be aware of? (i.e an inhaler, EpiPen, insulin etc.)

Acknowledgement of Terms

I acknowledge that my payment secures spot(s) for my child(ren) and is non-refundable after June 17.

I acknowledge that a completed Consent for Emergency Medical Treatment (LIC627) for the child(ren) listed above must be filed with Monica Ros before the start of camp.

I acknowledge that a completed Emergency Contact Form (LIC700) for the child(ren) listed above must be filed with Monica Ros before the start of camp.

Please fill out and return these forms to the office or via email at camps@monicaros.org prior to the first day of camp:

Emergency Contact Form

Consent to Emergency Treatment

Parent Handbook

Payment prior to camp start date secures your spot and is non-refundable.

Parent Handbook

Please complete the parent consent for administration of medications and medication chart below only if your child has a health condition or requires medication, such as an EpiPen, inhaler, etc. for their safety and well-being.

Return this form to camps@monicaros.org .