PopupCamp Registration Form

Date(s)
June 13th
AMPMEvening

June 14th
AMPMEvening

June 15th
AMPM

Parent's full name*

Parent's cellphone number*
(for emergency only)

E-mail adress

Child's full name*

Age*

Second Child full name (if needed)

Age of 2nd child

Third Child full name (if needed)

Age of the 3rd child

Knowned allergies
Please write the child's name followed with the allergy.

Does your child(ren) have any specific needs?*
(medication, temperament, others)

Persons allowed to access to your child(ren)*
(full names and phone number)

I authorize my child to visit the Movin'On site under the supervision of their accompanying teachers, and agree that by entering my child may be filmed, photographed and recorded, and that all material captured by Movin'On may be used by Movin'On and its partners for promotional purposes (see here).
YesNo

Any other comments?