CHILD'S INFORMATION
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| Child's First Name * |
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| Child's Last Name * |
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Child's Age * |
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| Child's Gender* |
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| Child's Date of Birth (MM/DD/YYYY format) * |
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What grade is your child this school year (2025-2026) * |
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Friend You may enter the name of ONE CHILD which you would like your child to be in the same group with. We cannot promise to honor all requests! |
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A t-shirt is included with registration. Please estimate your child's T-shirt size. * |
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Please choose the Summer or Music Camp option your child will be attending*
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| Does your child need Early Drop Off (8-8:45 am)?* |
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| Does your child need Late Pickup (5-6 pm)?* |
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Siblings who are 3-4 years old (as of 9/1/2025) are welcome to attend the Learning Ladders Summer Camp if there is any availability. Choose below to be added to the Waitlist. *
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PARENT/GUARDIAN INFORMATION
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Name of Parent(s)* |
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| Email * |
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| Verify Email * |
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| Home Address* | |
| Cell Phone (xxx-xxx-xxxx format) * |
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| Home Church * |
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ALLERGIES OR OTHER MEDICAL CONDITIONSPlease answer the below questions to help us create a safer and more engaging environment for your child.
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| List any known Allergies Put N/A if None * |
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Health issues we should be aware of (endocrine disorders, respiratory issues, cardiovascular issues, etc.) yes/no details if yes Put N/A if NONE** |
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Behavior factors we should be aware of (learning disabilities, challenging behaviors, etc.) yes/no (details if yes) Put N/A if NONE* |
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EMERGENCY CONTACT INFORMATION In the event we can not reach a parent, please provide an additional person we can contact.
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| Emergency Contact * |
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| Number (xxx-xxx-xxxx format) * |
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ACTIVITY PARTICIPATION RELEASE OF LIABILITY & PHOTO RELEASE
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Please read the attached Activity Participation Release of Liability & Photo Release, then print and sign it for your acceptance of the terms and conditions. You may bring it by the office, mail it, or bring it with you on the first day of camp. |
| Attached Document: | Release of Liability & Photo Release.pdf |
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