Enchanted Pink Tutoring

Registration Form Student

Please fill out form and submit to register your child.

Student's First and Last Name

Student's Age

Student's School and Grade

First Parent/Guardian

Cell Number

Address

Place of Work

Work Number

Second Parent/Guardian

Phone Number

Place of Work

Work Number

Relationship

Emergency Contact Phone Number

Name and Phone Number(s) of Person(s) Allowed to Pick Up Child Other than Parents

Any special instructions, such as custody or restraining orders must be attached to this application and discussed personally with the camp director.

All Information will remain Confidential.

Please include any other information you'd like us to know about your camper.

Student's Medical Information Form

The medical background of each camper is required as part of the camp’s registration process. The camp director must be advised in writing of any condition that would limit the camper’s ability to participate in any program.

Child's Name

Date of Birth

Child's Pediatrician's Name

Pediatrician's Phone Number

Date of Last Physical

Medical Conditions

List of Past Medical Treatments

List all current medications regardless of whether it needs to be taken at camp or not

Will your child need to take any prescription medications while at camp?

Yes

Does your child require an Epi-pen?

Yes

If yes, you must provide the camp with an Epi-pen to be kept at camp during your child’s enrollment. Epi-pen must be accompanied with a current prescription and a doctor’s note.

Parent Authorization Form

Enchanted Pink Tutoring does not discriminate on the basis of race, color, handicap, religion or national origin. Enchanted Pink Tutoring reserves the right at its sole discretion to refuse an application or dismiss a child from camp.

No refund will be made of fees paid before camp start date due to unforeseen circumstances and camper will not attend or if the child has attended any portion of the camping period.

By electronically typing your first and last name you are agreeing that you understand and accept these guidelines.

Signature

I give Enchanted Pink Tutoring permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at Enchanted Pink Tutoring and can be used for promotional purposes without notification.

I give permission for Enchanted Pink Tutoring to transport my child off camp property for the purpose of field trips and/or medical care. I understand that a schedule of events will be available to me and that all events are subject to change due to weather and/or scheduling conflicts without notice.

I authorize the camp management to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the camper involved. I am responsible for the expenses involved if the services of a physician or hospital are required. Please request a waiver for persons requesting exemption from medical treatment.

Preferred Hospital

By electronically typing your first and last name you are agreeing that you understand and accept these guidelines.

Signature