REGISTRATION – Summer Camp in Brooklyn Heights

Name *

First

Last

Date of Birth

Name of School of Attendance

Name of Parent/Guardian *

First

Last

Email *

Phone *

Please specify an emergency contact OTHER than the name specified in the Parent/Guardian Info above.

Name of Emergency Contact *

First

Last

Phone *

Weeks: *

UNSPECIFIED WEEK (Any week 1-6) – You will let us know the exact date by the end of June
Week 1: 7/8-7/12 American Cuisine (1)
Week 2: 7/15-7/19 Italian Cuisine (1)
Week 3: 7/22-7/26 Asian Cuisine (1)
Week 4: 7/29-8/2 South American Cuisine (1)
Week 5: 8/5-8/9 American Cuisine (2)
Week 6: 8/12-8/16 South American Cuisine (2)
Week 7: 8/19-8/23 Italian Cuisine (2)
Week 8: 8/26-8/30 Asian Cuisine (2)

Are you signing up for just a single day(s)? If so- please enter the date(s) here:

Any Food Allergies? *

Does the Child have an IEP *

Comments – Please specify any food allergies / IEPs / Other concerns you may have

If You Are Registering More than One Child, Please Enter Their Name and Age Below