Lakewood After Camp LTC

1. Child Information

Note: LTC is offering employees up to 10 free days. You will be able to purchase additional days after you submit this form.

Are you already a Glick Girl/Guy?

Yes!

First Name

Last Name

Grade Entering

How many free days?

Child #2 First Name

Child #2 Grade Entering

Child #2 How many free days?

Child #3 First Name

Child #3 Grade Entering

Child #3 How many free days?

Child #4 First Name

Child #4 Grade Entering

Child #4 How many free days?

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).

Note: Please don't register any child in a diaper for this program. Thank you!

2. Personal Information

Mother's Name

Mother's Cell

Father's Name

Father's Cell

Email Address

4. Submit

By 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

The form was sent successfully.

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After Camp Application

Lakewood - LTC

Apply Online

1. Child Information

Note: LTC is offering employees up to 10 free days. You will be able to purchase additional days after you submit this form.

2. Personal Information

3. Pick your Days

Girls Program

Boys Program

4. Submit