Pre Pesach 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 Grade Nursery GirlNursery BoyKindergarten GirlKindergarten BoyPre 1A GirlPre 1A Boy1st Grade Girl1st Grade Boy2nd Grade3rd Grade4th Grade Child #2 First Name Child #2 Grade Nursery GirlNursery BoyKindergarten GirlKindergarten BoyPre 1A GirlPre 1A Boy1st Grade Girl1st Grade Boy2nd Grade3rd Grade4th Grade Child #3 First Name Child #3 Grade Nursery GirlNursery BoyKindergarten GirlKindergarten BoyPre 1A GirlPre 1A Boy1st Grade Girl1st Grade Boy2nd Grade3rd Grade4th Grade Child #4 First Name Child #4 Grade Nursery GirlNursery BoyKindergarten GirlKindergarten BoyPre 1A GirlPre 1A Boy1st Grade Girl1st Grade Boy2nd Grade3rd Grade4th 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! Sunday March 26 Sunday March 26 Friday March 31 Friday March 31 Sunday April 2 Sunday April 2 Monday April 3 Monday April 3 Tuesday April 4 Tuesday April 4 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.
