|
CHILD'S
FIRST & LAST NAME:
SEX:
HEIGHT:
AGE: BIRTH DATE:
|
| GRADE
COMPLETED:
RISING GRADE: SCHOOL
ENTERING IN FALL:
|
| ADDRESS:
CITY / STATE / ZIP:
|
| PARENTS
NAMES:
CHURCH ATTENDED:
|
| HOME
PHONE: WHERE
DID YOU HEAR ABOUT OUR SCHOOL ?
|
| MOTHER'S
CELL PHONE:
FATHER'S CELL PHONE:
|
MOTHER'S EMAIL ADDRESS: FATHER'S
EMAIL ADDRESS:
_____________________________ (Please Print Clearly)
_____________________________________ |
|
WHAT ARE THE MOST IMPORTANT LESSONS
YOU WOULD LIKE YOUR CHILD TO LEARN? |
| EMERGENCY
CONTACT NAME
WHO
MAY PICK UP YOUR CHILD?
|
| ANY HEALTH
or LEARNING DIFFICULTIES? ANY FOOD ALLERGIES?
* Please attach information regarding any medical condition
which will impact your child's camp participation. |
| HEALTH
INSURANCE CARRIER:
CHILD'S HOBBIES, AWARDS, & ACCOMPLISHMENTS |
|
Photo Permission Release:
We take photos during the week to present during the
graduation for our parents and sometimes to feature on our
website or brochures. Occasionally a local newspaper or news
station asked to feature our camp in their paper or news show.
May we use your permission for your child's photo to be
featured on our web site or printed brochure?
YES NO |
THE FIRST
ACADEMY'S BEHAVIORAL EXPECTATIONS are aligned with Christ-like character
traits, such as obedience, self-control, kindness, and patience.
Students not adhering to these standards may be asked to withdraw from
the program. I HEREBY REQUEST that my son/daughter be admitted to The
First Academy Summer Program and authorize the staff to act for me
according to their best judgment in any emergency requiring medical
attention, for which I shall pay. Parent Guardian
Signature:____________________________________Date:_____________________ Make
checks payable to
Academy of Etiquette, and write "Summer
Etiquette Camp" in the memo blank. Fee must be paid in full for
registration to be accepted. Remember to mark your calendar and keep a photocopy of your camp
registration form for your records. Please use a separate registration
form for each child registering.
Please Mail Form with Class Fee to Hold Space in Class.
Credit Card Enrollment can be Faxed.
Please Make Checks Payable to Academy of Etiquette
TOTAL AMOUNT
ENCLOSED $ ____________________ Amount Enclosed____________________
Circle Credit Card - MC Visa
Discover AMEX
Credit Card #__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __Expiration
Date_____________
Name as it appears on the card:___________________________ Charge Amount
___________
Signature____________________________________________ Date
___________________
|
