Pre Pesach Application 100 BLVD 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! Please note: 100 BLVD is offering a total of 5 days for free. When selecting days, please only select a total of 5 days. If you would like to sign up your children for more than that, you can purchase more days on the homepage. First Name Last Name Grade Nursery Boy (toilet trained)Nursery Girl (toilet trained)Kindergarten Boy (toilet trained)Kindergarten Girl (toilet trained)Primary Girl1st Grade Girl2nd Grade Girl3rd Grade Girl4th Grade Girl 1. How many days? 1 Day2 Days3 Days4 Days5 Days Child #2 First Name Child #2 Grade Nursery Boy (toilet trained)Nursery Girl (toilet trained)Kindergarten Boy (toilet trained)Kindergarten Girl (toilet trained)Primary Girl1st Grade Girl2nd Grade Girl3rd Grade Girl4th Grade Girl 2. How many days? 1 Day2 Days3 Days4 Days5 Days Child #3 First Name Child #3 Grade Nursery Boy (toilet trained)Nursery Girl (toilet trained)Kindergarten Boy (toilet trained)Kindergarten Girl (toilet trained)Primary Girl1st Grade Girl2nd Grade Girl3rd Grade Girl4th Grade Girl 3. How many days? 1 Day2 Days3 Days4 Days5 Days Child #4 First Name Child #4 Grade Nursery Boy (toilet trained)Nursery Girl (toilet trained)Kindergarten Boy (toilet trained)Kindergarten Girl (toilet trained)Primary Girl1st Grade Girl2nd Grade Girl3rd Grade Girl4th Grade Girl 4. How many days? 1 Day2 Days3 Days4 Days5 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 3. Pick your Days Sunday March 26 Sunday March 26 Friday March 31 Friday March 31 Sunday April 2 Sunday April 2 Monday April 3 Monday April 3 Tuesday April 4 Tuesday April 4 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.
