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Camps
Summer Camp
Weekend Camps
About Us
About us
Our mission
Safety
Installations
Activities
FAQs
Contact
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Registration Form
A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.
Name
Last name
Mother's last name
Age they will have when attending the camp
Date of birth
Sex
Male
Female
Week
1st Week
2nd Week
3rd Week
4th Week
Start date
Departure date
# of weeks
School
Degree
Have you attended the glen in the summer?
No
Yes
DATA OF THE PARENTS
ADDRESS
Street
Num.
Suburb
ZIP
City
State
Tel. home
Mom's name
Cell phone
Email
Occupation
Tel. office
Dad's name
Cell phone
Email
Occupation
Tel. office
In case of emergency, in addition to the parents, call:
Name
Relationship
Cell phone
ADDITIONAL DATA
Do you have health insurance?
No
Yes
Which?
Specific activities to avoid
Do you have any illness?
No
Yes
Which?
Who recommended the camp to you?
Weight
Height
Blood type
Indicate if you have any of these conditions:
Seizures
No
Yes
Fainting
No
Yes
Asthma
No
Yes
Heart problems
No
Yes
Somnambulism
No
Yes
Breathing/Ear Problems
No
Yes
Migraine
No
Yes
Diabetes
No
Yes
Anemia
No
Yes
Other (specify)
Do you have any physical disability?
No
Yes
Specify
Have you been in psychological therapy recently?
No
Yes
Specify
Can you swim?
No
Yes
Toilet training at night
No
Yes
Do you have any type of allergy?
No
Yes
Specify
Have you recently suffered from any of these diseases? (please specify how long ago)
Conjunctivitis
No
Yes
Dengue
No
Yes
Lice
No
Yes
Influenza
No
Yes
How many days ago
How many months ago
Have you had surgery?
No
Yes
When?
About what?
Do you currently take any medication?
No
Yes
Specify name, dose, time and route of administration
If there is any special indication regarding the child's health, specify below
Name of your doctor
Specialty
Tel.
Cell phone
Name of the person signing
Signature
IMPORTANT:
Filling out this registration form does not reserve your spot in the camp, only the payment of the corresponding 50% deposit does.
. It is absolutely NECESSARY and indispensable to sign this registration form and the liability waiver to be enrolled in the camp. Registrations will be confirmed once the advance payment of 50% of the total payment has been received.
I AUTHORIZE THAT THE IMAGE OF MY CHILD MAY BE USED IN THE ADVERTISING MEDIA OF CAMPAMENTO LA CAÑADA SA DE CV, INCLUDING PRINTED MEDIA, BOTH DIGITAL (WEB PAGE AND SOCIAL NETWORKS) FOR PURPOSES OF ADVERTISING CAMPAMENTO.
I confirm that this information is reliable, in the same way I understand that any omission and/or erroneous information affects the responsibility of the Camp towards my child.
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