After Camp Application Lakewood - LTC Apply Online Please fill out all the required fields, and click Submit when you are done. 1. Child InformationNote: 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 Nursery (Boy) (3/4 yrs old)Kindergarten (Boy) (4/5 yrs old)Primary (Boy)1st Grade (Boy)2nd Grade (Boy)3rd Grade (Boy)4th Grade (Boy)Nursery (Girl) (3/4 yrs old)Kindergarten (Girl) (4/5 yrs old)Primary (Girl)1st Grade (Girl)2nd Grade (Girl)3rd Grade (Girl)4th Grade (Girl)5th Grade (Girl) How many free days? 12345678910 Child #2 First Name Child #2 Grade Entering Nursery (Boy) (3/4 yrs old)Kindergarten (Boy) (4/5 yrs old)Primary (Boy)1st Grade (Boy)2nd Grade (Boy)3rd Grade (Boy)4th Grade (Boy)Nursery (Girl) (3/4 yrs old)Kindergarten (Girl) (4/5 yrs old)Primary (Girl)1st Grade (Girl)2nd Grade (Girl)3rd Grade (Girl)4th Grade (Girl)5th Grade (Girl) Child #2 How many free days? 12345678910 Child #3 First Name Child #3 Grade Entering Nursery (Boy) (3/4 yrs old)Kindergarten (Boy) (4/5 yrs old)Primary (Boy)1st Grade (Boy)2nd Grade (Boy)3rd Grade (Boy)4th Grade (Boy)Nursery (Girl) (3/4 yrs old)Kindergarten (Girl) (4/5 yrs old)Primary (Girl)1st Grade (Girl)2nd Grade (Girl)3rd Grade (Girl)4th Grade (Girl)5th Grade (Girl) Child #3 How many free days? 12345678910 Child #4 First Name Child #4 Grade Entering Nursery (Boy) (3/4 yrs old)Kindergarten (Boy) (4/5 yrs old)Primary (Boy)1st Grade (Boy)2nd Grade (Boy)3rd Grade (Boy)4th Grade (Boy)Nursery (Girl) (3/4 yrs old)Kindergarten (Girl) (4/5 yrs old)Primary (Girl)1st Grade (Girl)2nd Grade (Girl)3rd Grade (Girl)4th Grade (Girl)5th Grade (Girl) Child #4 How many free days? 12345678910 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 3. Pick your DaysGirls Program Monday August 21 Monday August 21 Tuesday August 22 Tuesday August 22 Wednesday August 23 Wednesday August 23 Thursday August 24 Thursday August 24 Friday August 25 Friday August 25 Monday August 28 Monday August 28 Tuesday August 29 Tuesday August 29 Wednesday August 30 Wednesday August 30 Thursday August 31 Thursday August 31 Friday September 1 Friday September 1 Boys Program Monday August 14 Monday August 14 Tuesday August 15 Tuesday August 15 Wednesday August 16 Wednesday August 16 Thursday August 17 Thursday August 17 Friday August 18 Friday August 18 Monday August 21 Monday August 21 Tuesday August 22 Tuesday August 22 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 The form was sent successfully. An error occured.
