The Epic - Summer Camp 2021
Registration Form
登入 Google 即可儲存進度。瞭解詳情
電子郵件 *
Child's Full Name *
Primary Contact Number *
Age *
Date of Birth *
MM
/
DD
/
YYYY
T-Shirt Size *
Address *
Full Name of Parent/Guardian #1 *
Parents/Guardians will be contacted prior to staff reaching out to emergency contacts, when needed.
Work Number
Cell Number *
Email *
Full Name of Parent/Guardian #2
Parents/Guardians will be contacted prior to staff reaching out to emergency contacts, when needed.
Work Number
Cell Number
Email
Full Name of Emergency Contact #1
Phone Number of Emergency Contact #1
Full Name of Emergency Contact #2
Phone Number of Emergency Contact #2
Full Name of Emergency Contact #3
Phone Number of Emergency Contact #3
Full Name of Emergency Contact #4
Phone Number of Emergency Contact #4
Permission to pick up child *
必填
Are there any special situations regarding your camper's release?
Please list any special needs or allergies.
Swim Options - Please select *
Please mark the weeks you plan on your child attending camp (weeks are only officially reserved once paid for or put on auto-draft). *
必填
As the parent/guardian of the above named child, I herby do release and hold harmless the City of Grand Prairie, it’s employees, agents, volunteers, and contractors from any and all claims or demands arising out of the above named child participating in the program for which they are registered. I also give permission for emergency treatment by staff or physician if it is determined that such attention is needed. I also understand there is no insurance or reimbursement of costs associated with accidents. I give permission for the above named individual to participate in aquatic activities and to be transported to and from field trips, swimming, and other events. I agree to follow all camp policies and rules. *
系統會透過電子郵件將你的作答內容複本傳送到你所提供的地址。
提交
清除表單
請勿利用 Google 表單送出密碼。
reCAPTCHA
隱私權條款
Google 並未認可或建立這項內容。 檢舉濫用情形 - 服務條款 - 隱私權政策
Google 表單