Summer Camp Registration

Instructions Please complete this form for the upcoming cooking camp. Thank you.

Please Choose One: *
Santa Rita Ranch, Monday, June 18, 6pm-7pmWest Cypress Hills Elem, June 25-28, 9am-12pm

Student Name *
Student Age *
Student's Birthday *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Please Choose One: *
Car RiderAfter-School Care
Current School *
Grade Level *

Please list any allergies and/or conditions of your child (Type NONE if applicable) *
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone *
Consent Statement I give my consent and permission to Cook Learn Grow to provide medical attention to my child in the event of an emergency deemed necessary for the well-being of my child at my expense. This may include transportation to the nearest emergency center. If a field trip is offered, I give my consent and permission for my child to go on the Cook Learn Grow sponsored field trip as part of the camp experience. This includes transportation to and from the field trip designated for the week of camp via a private chartered bus, professional driver and CookLearnGrow chaperones. RELEASE OF LIABILITY: I hereby assume all risks, responsibility or danger incidental to any class, camp or event occurring prior to, during, or after the same and participant(s) agree not to bring any legal action against Cook Learn Grow, the owner, employees, my child's current preschool, daycare or school or sponsors in connection with such risk or danger so assumed. Photographs and/or video may be shot during class for the purpose of publicizing the Cook Learn Grow program(s). Parent or legal guardians agreement (indicated by checking the box where so indicated below) on this registration form authorizes the use of students' likeness in this manner. No refunds within 3 weeks of class/camp start date.