Contact

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Mini Summer Semester

Phone

3474593353

pninitom@gmail.com

Social Media

Child first Name

Last Name

Phone

Attendance days

Wednesday 6/14

Thursday 6/15

Friday 6/16

Authorized pickup person

Phone

Parent/Guardian 1

Phone

Parent/Guardian 2

Phone

if answered yes - please specify

In case of an emergency, I do hereby give authority to the camp and its staff to obtain necessary medical emergency treatment for my child with the understanding that every effort will be made to notify the family. I hereby authorize the doctor or the hospital to which my child may be brought (and whomever they may designate as their assistants) to perform any emergency procedures or operations, to give treatment and administer anesthetics to my child / children.

Photo Release - I authorize my child to be photographed/filmed/recorded on camp premises and during camp activities and/or for the camp to use such images in any camp communication, electronic or printed.

Yes

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