Pre Pesach Application Lakewood 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 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 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 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 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 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 DaysSave money by signing up for full program! 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 & Pay The form was sent successfully. An error occured.