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REGISTRATION
Gail
2022-03-03T17:15:46-06:00
2024 Summer Camp
Registration Date:
*
Name of Camper:
*
Camper's Date of Birth:
*
Below is for Parent Guardian Information
Parent/Guardian's Name:
*
Email address:
*
Daytime Phone:
*
Alternate:
Address (line 1):
*
Address (line 2):
City:
*
State:
*
Zip code:
*
In Case of Emergency, Contact:
Name #1
*
Relationship:
*
Phone #:
*
Email:
Name #2:
Relationship:
Phone #:
Email:
Pediatrician:
Phone:
Name of sibling or friend at this camp:
Dietary Restrictions:
*
Yes
No
If yes to dietary restrictions, please explain:
Immunizations up to date:
*
Yes
No
Covid-19 vaccinated?
*
Yes
No
Allergies:
*
Yes
No
Physical limitations:
*
Yes
No
If yes to physical limitations, please explain:
Currently on prescribed medication:
*
Yes
No
Permissions
Permissions
I give my permission for my child to take part in the Tea Time Etiquette Camp for Girls. This camper, to the best of my knowledge, is in good physical condition and can participate in moderate-level physical activities. I understand that all appropriate precautions will be taken for the safety of my child. In case of emergency, I give my permission to the Tea Time Etiquette Camp for Girls' staff to administer proper medical assistance or seek professional attention for the above-named camper. I hereby release, waive, hold harmless, and shall indemnify Tea Time Etiquette Camp for Girls, T-Time Etiquette Foundation, Inc., their agents and staff from liability from any and all claims in the event of injury to my child.
Other Terms and Conditions
Other Terms and Conditions:
Tea Time Etiquette Camp for Girls reserves the right to decline the registration or acceptance of any student for any reason.
Non-Refundable Registration Fee
I understand the registration fee is non-refundable and non-transferable.
Digital Signature
*
Date:
*
Instructions
Instructions
Section
Verification
Please enter any two digits
*
Example: 12
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