Pre Pesach Application 5 Towns Apply Online Please fill out all the required fields, and click Submit when you are done. Company 1. Child Information: Are you already a Glick Girl/Guy? Yes! Child #1 First Name * Last Name * Grade 2.5 year old Nursery (3 year old) Kindergarten Girl (4 year old) Kindergarten Boy (4 year old) Primary Girl (5 year old) Primary Boy (5 year old) 1st Grade Girl 1st Grade Boy 2nd Grade 3rd Grade Additional Children If your children will all be attending the same days, please fill out below. If they will be attending different days, please submit a new application for each child. Child #2 First Name Grade 2.5 year old Nursery (3 year old) Kindergarten Girl (4 year old) Kindergarten Boy (4 year old) Primary Girl (5 year old) Primary Boy (5 year old) 1st Grade Girl 1st Grade Boy 2nd Grade 3rd Grade Child #3 First Name Grade 2.5 year old Nursery (3 year old) Kindergarten Girl (4 year old) Kindergarten Boy (4 year old) Primary Girl (5 year old) Primary Boy (5 year old) 1st Grade Girl 1st Grade Boy 2nd Grade 3rd Grade Child #4 First Name Grade 2.5 year old Nursery (3 year old) Kindergarten Girl (4 year old) Kindergarten Boy (4 year old) Primary Girl (5 year old) Primary Boy (5 year old) 1st Grade Girl 1st Grade Boy 2nd Grade 3rd Grade Allergy: Please list anything your child is allergic to. If your child owns an EpiPen, please state: 2. Days Attending Sunday, March 21 Sunday, March 21 ($45) Tuesday, March 23 Tuesday, March 23 ($10) Wednesday, March 24 Wednesday, March 24 ($10) Thursday, March 25 Thursday, March 25 ($10) 3. Personal Information Mother's Name Mother's Cell Number Father's Name Father's Cell Number Email Address * Company 4. Submit By submitting this form, I agree to not send my child to camp: (a) if they have any Covid related symptoms or test positive for Covid-19 within 14 days; (b) have been in contact with anyone who has tested positive for Covid-19 or who has had symptoms of Covid-19 within 14 days. I will take my child's temperature daily before coming to camp. By clicking accept below, you are acknowledging that an inherent risk of exposure to COVID-19 exists in any public place where people are present. By registering your child in Glick, you and any legal guardian of your child, voluntarily assumes all risks related to exposure to COVID-19 and agree not to hold Glick Girl LLC liable for illness or injury. I give permission for the staff at Glick to deal with any medical emergencies and make any necessary medical decisions, and I agree to the terms and conditions as seen here. View Terms * Electronic Signature - Please fill in your full legal name. *