After Camp Application Lakewood - LTC/100BLVD 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 School Going Into Grade Nursery Boy (3/4 yrs old - toilet trained)Nursery Girl (3/4 yrs old - toilet trained)Kindergarten Boy (4/5 yrs old)Kindergarten Girl (4/5 yrs old)Primary BoyPrimary Girl1st Grade Boy1st Grade Girl2nd Grade Girl3rd Grade Girl4th Grade Girl5th Grade Girl 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). Please Note: Please don't register any child in a diaper for this program. 2. Personal Information Mother's Name Mother's Cell Father's Name Father's Cell Email Address Company Name Choose oneLTC100 BLVD 3. Pick your Days ALL DAYS ALL DAYS Monday Aug. 22 Monday Aug. 22 Tuesday Aug. 23 Tuesday Aug. 23 Wednesday Aug. 24 Wednesday Aug. 24 Thursday Aug. 25 Thursday Aug. 25 Friday Aug. 26 Friday Aug. 26 Monday Aug. 29 Monday Aug. 29 Tuesday Aug. 30 Tuesday Aug. 30 Wednesday Aug. 31 Wednesday Aug. 31 Thursday Sept. 1 Thursday Sept. 1 Friday Sept. 2 Friday 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. terms I agree Date Electronic Signature Submit The form was sent successfully. An error occured.
