Summer Camp Tuesday, May 28th-Friday, May 31stMonday, June 17- Thursday June 20thMonday, August 12th– Thursday, August 15th Camp Hours are 9:00 am – 12:00 pm. Preschool Summer Camp Registration For rising 2s, 3s, PreK, and Kindergarten Mother's Name* First Last Father's Name* First Last Parent Email Primary* Parent Phone Mobile*Name of Pediatrician* Phone Number for Pediatrician*Name of Health Insurance Company* Health Insurance Policy Number Name of Emergency ContactPlease provide one contact (other than yourself) in the event you cannot be reached above. First Last Relation to child* Emergency Contact Cell Phone*Media Release*Saint Jude uses images of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels. I hereby grant permission for Saint Jude the Apostle to use images of my child for internal or external communications. I agree to the media policy.Medical Consent*I/We, the undersigned parent(s) or legal guardian of a minor, do hereby give consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment or procedures and hospital care which is deemed advisable by, and is suggested, recommended, prescribed, or directed by any physician or surgeon duly licensed to practice in the State of Georgia. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatments will not be withheld if the undersigned cannot be reached. I agree to the medical consent and release policy.How many children are you registering?*123Child #1Child #1 Name* First Last Age as of 9/1/242345Gender* Female Male Does this child have any allergies or other health issues that could affect them during their time with us?* No Yes Please list allergies/health issuesCheck each week child #1 will attend*Cost: $150 per week OR $400 for all 3 weeks ($50 saving!) Tuesday, May 28th-Friday, May 31st Monday, June 17- Thursday June 20th Monday, August 12th- Thursday, August 15th Child #2Child #2 Name* First Last Age as of 9/1/242345Gender* Female Male Does this child have any allergies or other health issues that could affect them during their time with us?* No Yes Please list allergies/health issuesCheck each week child #2 will attend*Cost: $150 per week OR $400 for all 3 weeks ($50 saving!) Tuesday, May 28th-Friday, May 31st Monday, June 17- Thursday June 20th Monday, August 12th- Thursday, August 15th Child #3Child #3 Name* First Last Age as of 9/1/242345Gender* Female Male Does this child have any allergies or other health issues that could affect them during their time with us?* No Yes Check each week child #3 will attend*Cost: $150 per week OR $400 for all 3 weeks ($50 saving!) Tuesday, May 28th-Friday, May 31st Monday, June 17- Thursday June 20th Monday, August 12th- Thursday, August 15th Please list allergies/health issuesAfter you click Submit, you will be redirected to our payment page.CAPTCHA