Registration form

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Name

Last name

Mother's last name

Age they will have when attending the camp

Date of birth

Sex

Week

Start date

Departure date

# of weeks

School

Degree

Have you attended the glen in the summer?

PARENTS INFORMATION
ADDRESS

Street

Num.

Suburb

ZIP

City

State

Tel. home

Mom's name

Cell phone

Occupation

Tel. office

Dad's name

Cell phone

Occupation

Tel. office

In case of emergency, in addition to the parents, call:

Name

Relationship

Cell phone

ADDITIONAL DATA

Do you have health insurance?

Which?

Specific activities to avoid

Do you have any illness?

Which?

Who recommended the camp to you?

Weight

Height

Blood type

Indicate if you have any of these conditions:

Seizures

Fainting

Asthma

Heart problems

Somnambulism

Breathing/Ear Problems

Migraine

Diabetes

Anemia

Other (specify)

Do you have any physical disability?

Specify

Have you been in psychological therapy recently?

Specify

Can you swim?

Toilet training at night

Do you have any type of allergy?

Specify

Have you recently suffered from any of these diseases? (please specify how long ago)

Conjunctivitis

Dengue

Lice

Influenza

How many days ago

How many months ago

Have you had surgery?

When?

About what?

Do you currently take any medication?

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.

!Tu registro ha sido realizado correctamente!

Para concluir el proceso es necesario que descargues el siguiente documento, lo llenes, lo firmes y junto con una fotografía de tu identificación vigente lo envíes vía correo electrónico a: campamentolacanada@gmail.com ó Whatsapp al 33 5331 2284.

Si eres foráneo te enviaremos por email los datos para el deposito. En caso de estar en la ZMG de Guadalajara puedes pasar a nuestra oficina para realizar el pago, el domicilio es:

Av. Montevideo #2661, Col. Providencia. Guadalajara, Jalisco.

Descargar documento

No olvides, leer nuestros términos y condiciones

Gracias por ser parte de la familia Campamento la Cañada.

Registration Form

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!Tu registro ha sido realizado correctamente!