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24-25 Kindergarten Camp Registration Form
Kindergarten Camp will be on July 23, July 24, and July 25 from 9:00am-12:00pm.
Please call the school with questions or further details at 276-686-4125.
* Indicates required question
Email
*
Record my email address with my response
Student Name
*
Your answer
Address:
*
Your answer
List student allergies, medical conditions, or special needs:
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Gender
*
Choose
Male
Female
Prefer Not to Answer
Parent/Guardian Name:
*
Your answer
Parent/Guardian Address:
*
Your answer
Parent/Guardian Phone Numbers:
*
Your answer
(2) Parent/Guardian Name:
Your answer
(2) Parent/Guardian Address:
Your answer
(2) Parent/Guardian Phone Numbers:
Your answer
List all people who have permission to pick up the student from camp:
*
Your answer
Emergency Contact Name:
*
Your answer
Emergency Contact Address:
*
Your answer
Emergency Contact Phone Number:
*
Your answer
(2) Emergency Contact Name:
Your answer
(2) Emergency Contact Address:
Your answer
(2) Emergency Contact Phone Number:
Your answer
I give permission for my child to participate in the Wythe/Bland Kindergarten Camp Program. I also release from liability Smart Beginnings Wythe Bland, Wythe County Public Schools Foundation for Excellence, Inc.; Wythe County Public Schools; and other sponsors due to unforeseen occurrences that are beyond the control of teachers and administrators of the program.
*
Yes
No
I give permission for my child to be
photographed
, and for the photograph(s) to be used for publicity purposes during Kindergarten Camp.
*
Yes
No
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