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!

Child #1 First Name

Last Name

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

Child #3 First Name

Grade

Child #4 First Name

Grade

Allergy: Please list anything your child is allergic to. If your child owns an EpiPen, please state:

2. Days Attending

Sunday, March 21

($45)

Tuesday, March 23

($10)

Wednesday, March 24

($10)

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.

Electronic Signature - Please fill in your full legal name.