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ENROLLMENT
COMMMUNITY
SUMMER FUN CAMP
CONTACT

Strength

In

NUMBERS

Dantanay Academy Summer 2025 Enrollment

SUMMER CAMP 2025

CHILD'S FIRST AND LAST NAME *

CHILD'S ADDRESS*

PLEASE INCLUDE FULL ADDRESS WITH CITY, STATE AND ZIP

CHILD'S AGE*

CHILD'S BIRTHDATE*

CHILD'S GRADE *

CHILD'S T SHIRT SIZE*

CHILD'S FAVORITE THINGS*

CHILD'S EMERGENCY CONTACT/PICK-UP & RELEASE #1*

PLEASE INCLUDE NAME, NUMBER, EMAIL AND RELATIONSHIP

CHILD'S EMERGENCY CONTACT/PICK-UP & RELEASE #2*

PLEASE INCLUDE NAME, NUMBER, EMAIL AND RELATIONSHIP

CHILD'S EMERGENCY CONTACT #2*

PLEASE INCLUDE NAME, NUMBER, EMAIL AND RELATIONSHIP

CHILDS HEALTH CARE PROVIDER*

CHILDS INSURANCE POLICY #*

CHILDS DOCTOR AND PHONE NUMBER*

HOSPITAL PREFERENCE *

LIST ANY MEDICAL CONDITIONS *

IF NO MEDICAL CONDITONS PLEASE TYPE N/A

LIST ANY MEDICATION *

IF NO MEDICATION TYPE N/A

CHILD'S DIETARY RESTRICTIONS*

NONE

VEGETARIAN

VEGAN

KOSHER

GLUTEN-FREE

OTHER DIETARY RESTRICTIONS

I GIVE MY PERMISSION FOR MY CHILD/CHILDREN TO ATTEND THE WEEKLY FIELD TRIP OF MS. TEE’S SOCIAL DISTANCE SUMMER ENRICHMENT IN THE PROVIDED TRANSPORTATION OF MS. TEE’S .

YES

NO

FULL 7 WEEKS*

CHILD WILL ATTEND FULL SUMMER CAMP

JUNE 22 ( FIRST WEEK )

JUNE 29

JULY 6

JULY 13

JULY 20

JULY 27

AUGUST 3 ( LAST WEEK )

PARENT / GUARDIAN FIRST AND LAST NAME *

PARENT / GUARDIAN ADDRESS*

PLEASE INCLUDE FULL ADDRESS WITH CITY, STATE AND ZIP

PARENT EMAIL *

PARENT / GUARDIAN NUMBER*

LIST ANY CELL PHONE, WORK, HOME OR ADDTIONAL NUMBERS

PARENT / GUARDIAN ADDRESS EMAIL *

PARENT / GUARDIAN FIRST AND LAST NAME *

PARENT / GUARDIAN NUMBER*

LIST ANY CELL PHONE, WORK, HOME OR ADDTIONAL NUMBERS

PARENT / GUARDIAN ADDRESS EMAIL *

PARENT / GUARDIAN ADDRESS*

PLEASE INCLUDE FULL ADDRESS WITH CITY, STATE AND ZIP

I UNDERSTAND THAT I WILL HAVE TO PAY A $30 DEPOSIT TO SECURE MY CHILD'S SPOT AS WELL AS RECEIVE A T-SHIRT & SAFETY KIT*

YES

NO

I UNDERSTAND THAT I WILL HAVE TO PAY $75 EVERY MONDAY AND IF NOT I WILL BE CHARGED AN EXTRA $10*

YES

NO

I GIVE PERMISSION FOR MY CHILD TO BE PHOTOGRAPH*

YES

NO

Signature*

JUNE 22ND - AUGUST 8TH

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