AZ+A Summer Camp 2021
2319 N Orchard St.  |  Chicago, IL 60614  |  contact@amyzier.com  |  (773) 755-7791

Thank you to everyone who already registered for AZ+A Summer Camp 2021. The response has been overwhelming. We are now at full capacity, but have started a wait list should space become available. Please sign up as before, and we will let you know if and when a space becomes available.

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Email *
Child's/Children's Name *
Parents' Name *
Parents' Phone Number *
Child's/Children's Date of Birth *
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Child's/Children's T-Shirt Size(s) *
Please Check which session/s you would like to register for: *
Are you also interested in enrolling for the 2nd session if space is available? *We will contact you to confirm availability
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Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship to Child *
Primary Care Office Name *
Primary Care Physician Name *
Primary Care Physician Phone Number *
Primary Care Physician Fax Number *
Primary Care Physician Address *
Primary Care Physician City, State, Zip Code *
Is your child currently on any medications? If so, please list: *
Please list any allergies: (We will provide a snack) *
Is your child on a special diet? *
If yes, please list dietary restrictions, food allergies, and/or relevant medical directions *
Is there anything else we should know about your child's social, emotional, or medical profile?
Is there anything else we should know about your child?
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