Summer Camp Registration

Child Information

Child's First and Last Name

Age

Child's Birthdate

Gender

Girl

Boy

Potty Trained?

Yes

If not, there is a fee of $25 per week. We supply everything.

Primary Phone Number

Home Address

Apt, suite, etc.

Country

City

State

Zip code

Other members in household

Where does your child attend school?

Has your child attended our camps before?

Yes

If yes, you can just check off the camps you want to attend and skip down to medical waiver, If nothing (doctor, insurance, caregivers, etc) have changed.

Please list any buddies you want your child to be grouped with

Blossoming Buds Preschool Summer Camps

#1 Art Camp: July 10-14

#2 Dino Camp July 17-21

#3 Farm Camp July 24-28

#4 Jungle Safari Camp: July 31 - Aug 4

#5 Weird Science Camp Aug 7-11

#6 Ocean Camp: Aug 14-18

Please check the boxes of the camps you wish to attend

Important information we should know about your child: personality traits, likes/dislikes, habits, etc.

Parent/Guardian information

Parent/Guardian Name #1

Address Same as Student

Same

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Employer

Parent/Guardian Name #2

Address Same as Student

Same

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Employer

Other people allowed to pick-up

Name

Relation

Number

Name

Relation

Number

Name

Relation

Number

Medical Information

Pediatrician's Name

Phone

Health Insurance Provider

Please list all allergies and health issues

Please list all medications

Medical Waiver

I hereby give permission for my child to receive emergency treatment by a qualified staff member at Blossoming Buds Preschool. I also give permission for my child to be taken to the hospital by an aid car, ambulance, or staff car, if necessary.
In the event of an emergency and I cannot be contacted, I further consent to any medical, surgical, and/or hospital care, when deemed immediately necessary or advisable by a licensed physician/hospital in order to safeguard my child’s health.
I understand that I am 100% financially responsible for any emergency treatment that my child receives, including paramedics/ambulance services.
By signing below you agree to the above medical waiver.

Parent Signature

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Summer Camp Registration Form

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