Camper's Full Name
*
First Name
Last Name
Child's Age
*
Child's Birthdate
*
MM
DD
YYYY
Guardian 1 Full Name
*
Parent 1 or Guardian 1 Full Name
First Name
Last Name
Relationship to Child:
*
Guardian 1 Home Phone
*
Guardian 1 Cell Phone
*
(###)
###
####
Guardian 1 Home Address
*
You must enter your address even if it is the same as your child's permanent address.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Guardian 1 Work Address
*
if you work from home please state that. If you do not work, please answer with N/A
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Guardian 1 Work Phone
*
(###)
###
####
I would like to enroll in text alerts for emergency purposes
*
If you choose yes, standard text messaging rates may apply.
Cell Phone Carrier
*
Guardian 2 Full Name
*
First Name
Last Name
Guardian 2 Relationship To Child
*
Guardian 2 Home Phone
*
(###)
###
####
Guardian 2 Cell Phone
*
(###)
###
####
Guardian 2 Home Address
*
If the address is the same as Guardian 1, please write Same as Guardian 1.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Guardian 2 Personal Email
*
Guardian 2 Employee Address
*
If you do not work please write N/A
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Guardian 2 Employee Phone
*
(###)
###
####
Guardian 2 Work Hours
*
I would like to enroll in text alerts for emergency purposes.
*
If you are a single-parent household please select no for this option.
If Yes, please list your cell phone carrier
Emergency Contact 1
*
Please list the full name of the emergency contact
First Name
Last Name
Relationship to Child
*
Home Phone
*
This is for emergency contact 1
(###)
###
####
Cell Phone
*
This is for emergency contact 1
(###)
###
####
Address for Emergency Contact 1
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact 2
*
This must be a different person than emergency contact 1. This is required by law and for the safety of your child.
First Name
Last Name
Relationship to child
*
Home Phone
*
This is for emergency contact 2
(###)
###
####
Cell Phone
*
This is for emergency contact 2
(###)
###
####
Address for Emergency Contact 2
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact 3
*
Please provide the full name for emergency contact 3. this must be someone different than emergency contact 1 or 2.
First Name
Last Name
Relationship to child
*
Home Phone
*
This is for emergency contact 3
(###)
###
####
Cell Phone
*
This is for emergency contact 3
(###)
###
####
Address for Emergency Contact 3
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Illness: I understand that I will be notified should my child become ill during the day and that I will pick up my child promptly or make arrangements for an authorized emergency contact person to pick up within one hour of such notification. If my child is exposed or contracts a communicable disease, I agree to notify the camp and I understand that my child will be re-admitted according to the re-admission criteria in the family handbook.
*
Communicable Disease: I agree to inform the camp within 24 hours or the next business day after my child or any member of the immediate household has developed a reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately.
*
Communicable Illness Waiver: I hereby acknowledge the health risks associated with the transmission of all communicable disease (including the COVID-19 virus) and recognize that exposure to the COVID-19 virus, or other communicable diseases, could occur while my child is in the care of Little Ambassadors’ Academy, Inc (d/b/a Ambassadors Adventure Camp).
*
Emergency Medical Care I understand if there is an objection to seeking emergency medical care, a statement should be obtained from me stating the objection and the reason for the objection.
*
Medical Emergencies: I understand that Little Ambassadors' Academy, Inc (d/b/a Ambassadors Adventure Camp) will not be responsible for bills resulting from necessary care for students in emergencies. It is important that parents be aware of their responsibilities for any charges incurred.
*
Agreement
*
I have received a copy of the Ambassadors Adventure Camp (AAC) Handbook. I understand and will comply with the policies included in the AAC Handbook.
Electronic Signature
*
By typing your name below you are electronically signing and agreeing to this document.
First Name
Last Name
Date
MM
DD
YYYY
