2025 Avondale ELC Summer Camp Registration Form
Student Information
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Email *
Student First Name *
Student Last Name *
Student Birth Date *
MM
/
DD
/
YYYY
HALF DAY Enrollment Options (MUST choose 3, 4, OR 5 days OR select Full Day Option) *
Required
FULL DAY Enrollment Options (MUST choose 3, 4, OR 5 days OR select Half Day Option) *
Required
Allergies *
Medication *
Dietary Restrictions *
Student Address *
Primary Contact #1 Name *
Primary Contact #1 Relationship to Student *
Primary Contact #1 Phone Number *
Primary Contact #1 Email address *
Primary Contact #1 Employer *
Primary Contact #1 Work Number *
Primary Contact #2 Name
Primary Contact #2 Relationship to Student
Primary Contact #2 Phone Number
Primary Contact #2 Email address
Primary Contact #2 Employer
Primary Contact #2 Work Number
Emergency Contact Name *
Emergency Contact Relationship to student *
Emergency Contact Phone Number *
Siblings of child (name and age) *
Submit
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