Registration Child 1 * First Name Last Name Gender * Boy Girl Date of Birth * MM DD YYYY Grade Entering (rades 1-7) * School Attending * Does your child receive services during the school year? (If yes, please describe) * Special Needs or Allergies * Camp Application * Week 1 Week 2 Week 3 Additional Extra Care 25$/week, which covers both early & late care. Early Care Week 1 Week 2 Week 3 Late Care Week 1 Week 2 Week 3 T-shirt Size S M L XL Child 2 Name First Name Last Name Date of Birth MM DD YYYY Gender Boy Girl Camp Application Week 1 Week 2 Week 3 Additional late care application Week 1 Week 2 Week 3 Grade Entering (grades 1-7) School Attending Does your child receive services during the school year? (If yes, please describe) Special Needs or Allergies T-shirt size S M L XL PARENT INFORMATION Parent 1 * First Name Last Name Phone Number * Country (###) ### #### Address * Email * Occupation Work Phone * Country (###) ### #### Parent 2 First Name Last Name Phone Number Country (###) ### #### Email Work Phone Country (###) ### #### How did you hear of us? Emergency Information Emergency Contact (OTHER THAN PARENT) * First Name Last Name Phone Number * Country (###) ### #### Relationship * Pediatrician * First Name Last Name Phone Number * Country (###) ### #### Medicare * * Payment must be made by Monday June 17.* 1. I grant permission for my child to participate in all camp activities, including swimming and trips away from camp grounds (dates and destinations to be provided at a later date). 2. I understand that if my application is not filled out completely, my application will not be processed and will be returned. 3. I agree to disclose any behavioral help my child receives during the school year, to ensure that Camp has the ability to accommodate my child's needs. 4. I agree that my child may be photographed, and their pictures may be used in future camp promotional materials, including, but not limited to the brochure and the CGI website. 5. No camper will be permitted into camp without all forms completed (including medical and application) and all financial obligations satisfied. 6. CGI is not responsible for personal property brought to camp. 7. If the Camper’s conduct is harmful to the best interests of CGI Day Camp, the Camper may be dismissed at the sole discretion of the Director with no refund nor reduction of fee. Thank you! For any question feel free to contact us any time Contact Us
