JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2021 Spring Break Camp Registration
Registration Form and Release Waiver for Summer Camp
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Name:
*
Your answer
Sex:
*
Female
Male
Required
Date Of Birth:
*
MM
/
DD
/
YYYY
Address:
*
Your answer
Cell Number:
*
Your answer
Work Number:
Your answer
Email Address:
*
Your answer
Are there any medical conditions to which we should be informed?
*
No
Yes
If yes, please explain:
Your answer
Parent(s) Names
*
Your answer
Has this student ever been enrolled with us before?
Yes
No
Clear selection
In case of an emergency and we are unable to reach you, please list two (2) additional emergency contacts.
*
Your answer
I allow my child to be photographed, videotaped, or recorded for educational, training, advertising, and web site purposes.
*
Yes
No
Please send your child with a Lunch each day. We will provide snacks.
*
Got it!
Next
Page 1 of 2
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
