Registration Form - ADEP Coaching : ADEP Coaching

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Home
Mission
FAQ
About
Services
Camp ADEP
Testimonials
Contact

Registration Form

(option to complete electronically below or a paper copy on the first day before drop off):

Register today

Number of children you want to sign up for Camp ADEP:(Required)

#1 Child Name(Required)

First Last

#1 Child Date of Birth(Required)

MM slash DD slash YYYY

#1 Child Current Age(Required)

#1 Child - Any Allergies?(Required)

Yes

No

Please indicate all allergies:(Required)

#2 Child Name(Required)

First Last

#2 Child Date of Birth(Required)

MM slash DD slash YYYY

#2 Child Current Age(Required)

#2 Child - Any Allergies?(Required)

Yes

No

Please indicate all allergies:(Required)

#3 Child Name(Required)

First Last

#3 Child Date of Birth(Required)

MM slash DD slash YYYY

#3 Child Current Age(Required)

#3 Child - Any Allergies?(Required)

Yes

No

Please indicate all allergies:(Required)

Any Restrictions/Notes:(Required)

Parent Name(Required)

First Last

Parent Phone Number(Required)

Parent Email(Required)

2nd Contact Name(Required)

First Last

2nd Contact Relation(Required)

2nd Contact Phone Number(Required)

Child Address(Required)

Street Address Address Line 2 City State ZIP Code

Name(s) of Individuals AUTHORIZED to pick up:(Required)

Name(s) of Individuals NOT AUTHORIZED to pick up:(Required)

Signature

June 13 - August 18

Ages 5 - 14

Monday - Thursday
10 am - 3pm

1 child = $15/hr
2 children = $25/hr

For more information about location, additional hours and other details, email: [email protected]

[email protected]

781-258-3903
© ADEP Coaching. All rights reserved