Fantastic Beasts Camp Registration Form

Parent/Guardian #1 name:
e-mail
phone #1
phone #2
Parent/guardian #2 name
Parent/guardian #2 e-mail
Parent/guardian #2 phone #1
Parent/guardian #2 phone #2
Child #1 name:
Grade entering, fall 2017
Uses a car seat
Describe level of swimming ability
Dietary needs
Allergies or other special needs
Child #2 name
Child #2 grade entering, fall 2017
Child #2 uses a car seat
Describe level of swimming ability of child #2
Child #2 dietary needs
Child #2 allergies or other special needs
Child #3 name
Child #3 Grade entering, fall 2017
Child #3 uses a car seat
Describe level of swimming ability of child #3 name
Child #3 dietary needs
Child #3 allergies or other special needs
Insurance company
Insurance policy #
Emergency contact name
Relation
Phone:
-
I give permission to First UU San Antonio to use pictures of my child at camp on our web site, newsletter, and social media. I understand that no names will be attached.
I hereby give my consent and authority for the Director of Lifespan Religious Education of First Unitarian Universalist Church of San Antonio (or designee) to ensure the safety, health, and welfare of my child/ward. I hereby absolve the staff and First Unitarian Universalist Church of San Antonio of liability. I give consent for any necessary medical treatment, including emergency surgical care, if needed.
You can pay by Paypal, or send a check to First UU San Antonio, 7150 W Interstate 10, 78213. Nonrefundable deposit of $25 is due by July 1.
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