SATURDAY CLUB FORM Please enable JavaScript in your browser to complete this form. Stay connected with old and new friends! Join us Saturday mornings from 9-12 for ages 3-7. Name *Birthday *Gender *GenderMaleFemaleParent 1 Name *Parent 1 Phone *Parent 1 EmailParent 2 NameParent 2 PhoneParent 2 Email Credit Card Information - Secure *FirstLastPlease select the number of Saturdays you would like to register for (You can always add additional Saturdays)1 - Saturday $956 - Saturdays $5508- Saturdays $70010 - Saturdays $85012 - Saturdays $960Please and choose the days your child will be attending *September 19thSeptember 26thOctober 3rdOctober 10thOctober 17thOctober 24thOctober 31st (Halloween-Themed)November 7thNovember 14thNovember 21November 28thDecember 5thDecember 12thDecember 19thCheck boxes below to indicate if your child has any allergies, special needs/services, or medical conditions:AllergiesAsthmaMedical ConditionsSpecial EducationOccupational/ Physical TherapySpeech/Language DelayAgreements *I consent to emergency medical treatment for my childAgreements *I understand my child may not attend camp if he/she has one or more of the following symptoms. Fever over 100.4, vomiting, diarrhea, undiagnosed rash, has started antibiotics in the past 24 hours, congestion/coughing. We kindly ask that you keep sick children home for minimum of 24 hours.Agreements *I understand that I am responsible for ensuring my child is covered by health insurance and that any injury or illness incurred at camp is the financial responsibility of the parent and not that of The Country SchoolAgreement *I give my permission for my child’s photograph to be used on social media or for advertising purposesAgreements *Arrival/Dismissal - We implement curbside drop off and pick up. Please arrive at Saturday club between 8:55-9:00 and pick up between 11:55-12:00. Please be prompt when picking up your child.AgreementsI give permission for my contact information to be shared with other parents.Emergency Contacts/Approved Pick-Up Contacts Other Than The Parent *FirstLastEmergency Contacts/Approved Pick-Up Contacts Other Than The ParentFirstLastEmergency Contacts/Approved Pick-Up Contacts Other Than The ParentFirstLastLead SourceSubmit
