Summer Camp Registration Request Form - 2023
Please complete this form separately for each child you wish to register for NPESC 2023 summer camp program to be held at Bridle Path Elementary School.
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Child's first name *
Child's last name *
Child's Address  (#, street) *
Child's Address  (town, state, zip code) *
First Name of enrolling parent/guardian *
Last Name of enrolling parent/guardian *
Parent/Guardian's cell phone number *
Parent/Guardian's email address *
Grade child will be entering for the 2023-24 school year *
Child's date of birth (MM/DD/YEAR) *
Indicate the school your child will be attending for the 2023-24 school year. *
Child's Gender *
Student ID #
Customer #
Does your child have an IEP, 504 plan or other special need of which we need to be aware? *
Do you have a custody agreement, requiring the attention  of staff at pick-up time?  (Please submit a copy of any custody order along with enrollment paperwork.) *
Does your child require medication during program hours?  (Medication administration form/medication must be submitted on the first day of care.) *
Does your child have asthma, requiring an inhaler be kept on hand at all times?  (Action plan required at the time of enrollment.  Please submit a medication administration form/medication on the first day of care.) *
Does your child have an allergy, requiring an Epi-pen be kept on hand at all times?  (Action plan required at the time of enrollment.  Please submit a medication administration form/medication on the first day of care.) *
I participate in the Montgomery County ELRC, subsidized child care program and am approved to receive those funds.
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Are you enrolling more than one child? *
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