REGISTER BELOW Parent/Guardian Name * First Name Last Name Parent/Guardian Phone Number * Parent/Guardian Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Summer School Attendance Preference * For your convenience, payments may be made in two installments. One payment to cover the first three weeks and the second payment, made the fourth week, to cover the last three weeks. 6 weeks (Monday-Friday) - Cost $1,200 3 weeks (Monday-Friday) - Cost $600 6 weeks (Monday/Wednesday) - Cost $750 6 weeks (Tuesday/Thursday) - Cost $750 I need Morning Day Care 7:15a - 7:45a * 1 child - $7/day 2 or more children - $10/day I do not need Morning Day Care. I need Afternoon Day Care (includes an hour of academic support). 3:30p - 5:30p * 1 child - $10/day 2 or more children - $15/day I do not need Afternoon Day Care. I am interested in my child(ren) participating in a separate coding class from 3:30 – 4:30 for 12 sessions at $50 per session. * Yes No I am undecided STUDENT(S) INFORMATION Student #1 Name * First Name Last Name Student #1 Birthday * MM DD YYYY Student #1 Gender * Male Female Did Student #1 attend SGA for the 2022–2023 school year? * Yes No Grade level that your student #1 just completed. * TK K 1 2 3 4 5 6 7 8 9 10 11 12 Student #1 Allergies (If none, please type in "NONE") * Does student #1 require special services. * Yes No If your child does require special services, please explain. Student #2 Name First Name Last Name Student #2 Birthday MM DD YYYY Student #2 Gender Male Female Did Student #2 attend SGA for the 2022–2023 school year? Option 1 Option 2 Grade level that your student #2 just completed. TK K 1 2 3 4 5 6 7 8 9 10 11 12 Student #2 Allergies (If none, please type in "NONE") Does student #2 require special services. Yes No If your child does require special services, please explain. Student #3 Name First Name Last Name Student #3 Birthday MM DD YYYY Student #3 Gender Male Female Did Student #3 attend SGA for the 2022–2023 school year? Yes No Grade level that your student #3 just completed. TK K 1 2 3 4 5 6 7 8 9 10 11 12 Student #3 Allergies (If none, please type in "NONE") Does student #3 require special services. Yes No If your child does require special services, please explain. EMERGENCY AND MEDICAL INFORMATION Emergency contact #1 name and phone number * Emergency contact #2 name and phone number * Is there a medical condition we need to be aware of? (If there is no medical condition, please write, "NONE") * IF MEDICAL ATTENTION IS NECESSARY, I AGREE TO HAVE MY SON/DAUGHTER TAKEN TO A MEDICAL FACILITY AND TO HAVE MEDICAL ATTENTION RENDERED AS NECESSARY BY THE ATTENDING PHYSICIAN. * Yes No By typing my name below I acknowledge that I am registering my child(ren) for SGA's Summer Day Camp 2023. * I understand that I need to complete payment in order for my student(s) to be fully registered for Summer Day Camp 2023.. I understand If you have any comments, please state them below. Thank you!