Monday, August 9th - Friday, August 13th - 9:00 a.m. - 12 NOON - For Ages 4 - 12

Explore Egypt

Parent or Guardian's Name*

Parent or Guardian's Email Address*

Address*

City*

State*

Zip Code*

Telephone*

Child's Name*

Birth Date (mm/dd/yyyy)*

Grade*

List any special needs or disabilities you want us
to know about

List any allergies we should know about. (peanuts,
bee stings...)

List all Medications

Name of Emergency Contact*

Emergency Contact Telephone*

Relationship*

How did you hear about this program?*

PHOTO RELEASE: I give permission to use
photographs taken of my child for promotional
purposes*

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