JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Summer Camp Registration Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name of the Trailblazer
*
Your answer
Birth date of Trailblazer attending
*
MM
/
DD
/
YYYY
Address
*
Your answer
Gender
*
Female
Male
Required
Does the attending Child have any health conditions, allergies, or family issues we should be aware of?
*
Yes
No
Please list all allergies (environmental, food, medicines or other), or any other condition we should be aware of.
Your answer
Will you need Before/After-Care 7:00 A.M. - 6:00 P.M.
Yes (Extra fee - $60, it covers the whole week)
No
Clear selection
Mother's Name/ Guardian
*
Your answer
Mother's email / Guardian
*
Your answer
Mother's phone number / Guardian
*
Your answer
Father's Name/ Guardian
*
Your answer
Father's email / Guardian
*
Your answer
Father's phone / Guardian
*
Your answer
Name of person other than parent/guardian to be notified in emergency situation when parent is not available.
*
Your answer
Email of person other than parent/guardian to be notified in emergency situation when parent is not available.
*
Your answer
Phone number of person other than parent/guardian to be notified in emergency situation when parent is not available.
*
Your answer
Person other than parent/guardian to be notified in emergency situation when parent/guardian in not available.
Name, E-mail and Current Address.
Your answer
Please state if any person other than the parent/guardian is authorized for pick-ups and drop-offs.
Name, E-mail and Current Address.
Your answer
Does the attending Trailblazer have any spacial needs or consideration we should take into account while in our care?
Your answer
Please let us know any other consideration that will help us make summer camp a unique experience for the young Trailblazer.
Your answer
Camping time 9:00 A.M. - 4:00 P.M.
*
5 Days - $200
3 Days - $165
Will you need Before/After-Care 7:00 A.M. - 6:00 P.M.
Yes (Extra fee - $60, it covers the whole week)
No
Clear selection
How many weeks will the trailblazer stay with us?
*
1
2
3
4 if you register for 4 weeks or more a discount will be applied
5
6
7
8
9
Which of the week will the Trailblazer be with us? specify dates.
*
Your answer
Payments Option
Brigthwheel
Check
Cash
Cash App / send it to: $WJAPreschool memo: Summer Camp name: Annette Boyd
Clear selection
Submit
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
