JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Summer Programs Health Form
Sign in to Google
to save your progress.
Learn more
Name of Class(s)
Your answer
Date(s) of Class(s)
Your answer
Attending Child (first and last name)
Your answer
Parent/guardian first and last name
Your answer
Parent/guardian phone number
Your answer
Emergency Contact first and last name
Your answer
Emergency contact phone
Your answer
Emergency contact relationship to child
Your answer
Any allergies, accommodations, or anything else we should know? (type n/a if nothing)
Your answer
Do you consent to your child being photographed during this event to be used for promotion and social media?
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of nbymhnc.org.
Report Abuse
Forms
