2021 International Summer Camp Registration

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Email *

Date of this Registration: *

YYYY

Child's Name: (one form per child) *

Date of birth: *

YYYY

My child will be enrolled as an: *

Investigator ( Age 3 ) Birthdate by June 1, 2021

Adventurer ( Age 4 ) Birthdate by June 1, 2021

Trailblazer ( Age 5 ) Birthdate by June 1, 2021

Pathfinder ( Age 6-12 ) Birthdate by June 1, 2021

Is this registration: *

First and only registration submitted for this child.

An addition or correction to a prior registration submitted and should supersede the prior registrations submitted. Please indicate what is being changed in next section.

Please specify below, exactly what is being changed within this submission. (Please DO NOT mark weeks on the chart you have already scheduled prior. You may run the risk of being double charged.) ONLY mark weeks you are ADDING and specify below what you are DELETING:

Address: *

Parent/Guardian Names, Cell Phone Numbers, and Email Addresses: *

Name Two (2) Emergency Contacts (other than parents mentioned above) to which child may be released - include their phone numbers and relationship to child: (Photo ID will be Required at time of pick up.) *

Include any allergies or health restrictions your child may have: *

Will the above require medication to be kept in school building? (If Yes, an Action Plan MUST be obtained and submitted to front office, asap.) *

Yes

I understand that I will apply sunscreen on my child every morning before drop off, and I am also giving permission to The Glen staff to re-apply sunscreen on my child as needed. *

Yes, I agree with the above statement.

5 Day Option - Enter all weeks and programs you are registering for 5 days. Due dates apply. Times and costs are listed within Parent Camp Handbook. (Please DO NOT mark weeks on the chart you have already scheduled prior. You may run the risk of being double charged.) ONLY mark weeks you are ADDING and specify above what you are DELETING:

Morning Session $137.

Regular Session $200.

Row 1

3 Day Option - Only complete if your child will attend 3 days within any weeks. Due dates apply. Times and costs are listed within Parent Camp Handbook. (Please DO NOT mark weeks on the chart you have already scheduled prior. You may run the risk of being double charged.) ONLY mark weeks you are ADDING and specify above what you are DELETING:

Morning Session $ 95.50

Regular Session $126.

Monday

Tuesday

Wednesday

Thursday

Row 1

Person filling out this form and relationship to child. *

I understand that The Glen Montessori School assumes no responsibility for the injuries or illness in which my child may sustain as as result of my physical condition or resulting from my child's participation in any fitness or athletic activities, sports, programs, the use of any equipment, or other activities. I expressly acknowledge on behalf of myself and my heirs that I assume the risk for all injuries and illness which may result from participation in these activities. In consideration of being permitted to enter The Glen Montessori School, I hereby release and discharge The Glen Montessori School and its administration, faculty, and/or employees from any and all claims for injury, illness, health, loss, or damage which I/my child may suffer as a result of my child's participation in these activities. I understand that The Glen Montessori School is not responsible for personal property lost or stolen. I understand the photographs of all participants can be used in promotional literature unless specifically stated in writing not to be used. My acknowledgment below identifies my understanding of the terms of this consent. Parent's Authorization: This child's health history is correct so far as I know and the person herein described has permission to engage in all prescribed activities, except as noted by me and the examining physician. In the event I cannot be reached in an emergency, I hereby give permission to the physician elected by the Camp Director to hospitalize and secure proper treatment for my child as named above. I have received and read the "Parent Handbook" section in the International Summer Camp Brochure. I hereby agree to follow the rules and policies set forth in the "Parent Handbook." *

Yes, I have read and agree to the terms stated above.

A copy of your responses will be emailed to the address you provided.

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