After Camp Application 5 Towns Apply Online Please fill out all the required fields, and click Submit when you are done. 1. Child Information Are you already a Glick Girl/Guy? Yes! First Name Last Name Age 3 year old4 year old5 year oldEntering 1st GradeEntering 2nd GradeEntering 3rd Grade Child #2 First Name Child #2 Age 3 year old4 year old5 year oldEntering 1st GradeEntering 2nd GradeEntering 3rd Grade Child #3 First Name Child #3 Age 3 year old4 year old5 year oldEntering 1st GradeEntering 2nd GradeEntering 3rd Grade Child #4 First Name Child #4 Age 3 year old4 year old5 year oldEntering 1st GradeEntering 2nd GradeEntering 3rd Grade Allergy: Please list anything your child is allergic to. If your child owns an EpiPen, please state: Does your child receive extra assitance in a school/camp setting? (This way we can ensure to provide properly for your child). 2. Personal Information Mother's Name Mother's Cell Father's Name Father's Cell Email Address 3. Pick your DaysSave money by signing up for full program! ALL DAYS ALL DAYS Mon. Aug 22 Mon. Aug 22 Tues. Aug 23 Tues. Aug 23 Wed. Aug 24 Wed. Aug 24 Thurs. Aug 25 Thurs. Aug 25 Fri. Aug 26 Fri. Aug 26 Mon. Aug 29 Mon. Aug 29 Tues. Aug 30 Tues. Aug 30 Wed. Aug 31 Wed. Aug 31 Thurs. Sept 1 Thurs. Sept 1 Fri. Sept 2 Fri. Sept 2 4. SubmitBy registering your child in GlickGirl, you and any legal guardian of your child give permission for the staff at GlickGirl to deal with any medical emergencies and make any necessary medical decisions, and agree not to hold Glick Girl LLC liable for illness or injury. I agree to the terms and conditions as seen here. I agree Date Electronic Signature Submit & Pay The form was sent successfully. An error occured.
