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Home
Services
Personal Chef
Catered Events
Meal Shopping
Camps
Classes
Gallery
Menus
Brunch
Hors d' Oeuvres
Entrees & Sides
Contact Us
Summer Camp Registration
Child Information
Child Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Date of Birth
*
MM
DD
YYYY
Parent or Guardian Information
Parent or Guardian
*
Parent or Guardian
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email Address
*
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Email
*
Emergency Contact Phone Number
*
MM
DD
YYYY
Medication Information
Medications, Dosages, Times Taken
*
If you child does not require any medications please indicate by writing "No Medications".
Authorizations
Video/Photo Authorization
*
I give permission for Rita’s Meals Made By Design Summer Camp to include my child in program photos and videos. I understand that these become the property of the said camps to be used for promotional purposes, and I authorize such use without compensation.
Yes
No
Authorized Pickup Designates
*
First Name
Last Name
First Name
Last Name
First Name
Last Name
Behavior Discipline Policy
*
Rita’s Meals Made By Design has the right to redirect & assert reasonable discipline as needed for behavior issues & reserves the right to revoke participation & membership to participants whose behavior impedes the learning or endangers other camp attendees. If for any reason membership is revoked payments will not be returned.
I have read the Behavior Discipline Policy
Release & Hold Harmless Statement
*
I understand that despite safety precautions there is always a risk of accidental injury. I as the parent or guardian of the participant named herein, assume all risks and hazards incidental to any camp activities from responsibility and agree to indemnify and hold these businesses, camp counselors, directors, drivers, volunteers, and all employees harmless for any illness or injury to me, my child, or family members occurring during camp activities, field trips, or other recreational facilities. I have fully read the emergency authorization, medication policy, release & hold harmless statements, video/photo authorization, and behavior/discipline policy on this application. As a parent or legal guardian I hereby consent to having my child participate in the program & have gone over all needed information with my child.
I have read the Release & Hold Harmless Statement
Thank you for registering for Summer Camp with Rita.