Preschool Summer Camp Enrollment Form

Child's Enrollment Form

Child's name

Age

Date of Birth

Sex

Telephone Number

Home Address

School Name

School/Grade Level

What Is The Child Applying For?

Picture upload

Camper's Photo (Optional)

PARENT/GUARDIAN INFORMATION:

The parents/guardian listed below will be the authorized person to pick-up the child after the camp/Lesson.
The parents/guardian listed below will also be the primary emergency contact person.

Name

Relation

Phone Number

Picture upload

Name

Relation

Phone Number

Picture upload

MEDICAL INFORMATION:

Does the child have any allergies? If yes, please list them below:

Does the child have any previous injuries? If yes, please explain them below:

Does the child have any current medical conditions? If yes, please list them below:

Does the child take any medication? If yes, please list them below and explain its purpose:

AUTHORIZATION:
1) I, the parent/guardian give consent for the child to participate in all activities in the camp/lesson.
2) 2) I, the parent/guardian of this child gives authority to the staff of this camp/lesson to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached

- I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
- I released the organizers, coaches, staff, or managers of this camp/lesson for any responsibility in case of accident, illness, or injury during my child's enrollment.
- I confirm that all information given in this form is true, complete, and accurate.

Agree

Agree By Submitting This Form, You Have Signed That All The Information Provided Is True.

ROOKIES CONSULT

We believe that every child deserves the best start in life and that‘s why we are committed to promoting the Montessori method to help children reach their full potential.