Summer Camp Registration: Superheroes

Name: Cheers N Paint
Address: 2773 NC Hwy 55, Cary, NC, 27519, United States
Telephone: +1-919-995-6238
Price range: $$

Fill Out Form & Submit

Contact Details
Student Name*
First Last
Age*
School
Address*
Street Address Address Line 2 City State ZIP Code
Parent's Phone*
Student's Email
Parent's Email*
1st Parent/Guardian*
First Last
Cell Phone*
Place of Work*
Work Phone*
2nd Parent/Guardian
First Last
Cell Phone
Place of Work
Work Phone
Emergency Contact*
First Last
Relationship*
Phone*
Cell Phone*
Child Resides With*
- 1st Parent
- 2nd Parent
- Guardian
- Both
- Other
Name & phone number of people other than parents allowed to pick up your child
Name
First Last
Phone
Name
First Last
Phone
Name
First Last
Phone
Name
First Last
Phone
Name
First Last
Phone
Any special instructions, such as custody or restraining orders must be listed here and discussed personally with the camp director. All information will be kept confidential.
Does this child have any food or other allergies? If yes, please list each allergy and reaction in a separate line.*
- Yes
- No
Allergy/Reaction
Allergy/Reaction
Allergy/Reaction
Allergy/Reaction
Please list any other information you'd like to include about your camper.
Email
This field is for validation purposes and should be left unchanged.