Ross Community Center: 2024 Reading Camp 
June 10th-13th
2PM-5PM
ages 5-10
FREE

There is an optional drop off time between 1pm-2pm where each student can receive a free lunch.
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Name of Participant  *
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Date of Birth *
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Child's Age *
Address, City, Zip *
School Attending  *
Grade *
Parent/Guardian Name *
Parent/Guardian Home/Cell Phone Number *
Parent/Guardian Email *
Person to call in case of emergency, if unable to contact Parent/Guardian: (Name, telephone number, and relationship with the participant)
 *
My Child has Permission to arrive/leave the Ross Center by:
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Parent/Guardian Authorization
I hereby authorize my child to attend after school programs at the Ross Community Center:I also give permission to the Ross Community Center to videotape and take photographs of my child for the purpose of publication of events at the Center, in print, presentations, on their website and social media. I understand that no royalty, fee, or other compensation shall be payable to me by reason of use. I also release Ross Community Center staff and volunteers from liability.
Parent/Guardian Authorization *
Parent/Guardian Signature *
Date *
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The following persons have my permission to pick my child up from the Ross Community Center:
Person No.1 (Name, Relationship to Child, Telephone Number)
Person No.2 (Name, Relationship to Child, Telephone Number)
Person No.3 (Name, Relationship to Child, Telephone Number)
Parent/Guardian Signature *
Date *
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