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Sprouts Summer Camp
Ages 4-6
July 6-8 (Wednesday-Friday) from 10am-1pm
Location: Sprouts Academy 801 NE 194th St. Ridgefield WA 98642
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Student name:
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Your answer
Student date of birth
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Your answer
Student's T-shirt size?
X-small
Medium
Small
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Home Address
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Your answer
Parent 1 name
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Your answer
Parent 1 cell phone number
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Your answer
Parent 2 name
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Your answer
Parent 2 cell phone number
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Your answer
Primary Email:
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Your answer
Best Person to receive texts and phone calls?
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Parent 1
Parent 2
Emergency contact name (other than parents)
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Your answer
Emergency contact relationship to child
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Your answer
Emergency contact phone number
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Your answer
Allergies or medical conditions (Please ask teachers if you need a medical form for permission to administer medication)
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Is there anyone other than the parents listed that is allowed to pick up your child? Please list names as they appear on identification or write NO
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Is it okay for Sprouts Academy to use your child's photograph for promotional purposes online and/or in printed format?
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Yes
No
Would you like your information to be accessible to other parents from Sprouts Academy for birthday invitations or scheduling playdates?
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Yes, phone number and email
Yes, just phone number
Yes, just email
No, please do not share contact information with other parents at the school
By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge:
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