Full Name

Date of Birth

Age

Gender
MaleFemale

Blood Group

Do child have any allergies/Conditions including, but not limited to:
NothingNutsChocolateRed DyeFruitsProcessed FoodsMilkSoyBees or WaspsAsthma, Epilepsy, AutismOther

Please mention any behaviors of the kid that may need special care:

Note: Kids with any Medical Condition have to provide a doctor’s certificate mentioning that the child can attend the summer camp.

Parent/Guardian Full Name

Relationship with the ward

Primary Contact No.

Secondary Contact No.

Email ID

Present Address

Please list name of people who have permission to pick up your child other than you:

Emergency Contact or Family Doctor number

Medical Insurance Company

Insurance Number

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