Child's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Will you register a sibling? *

We offer a discount of 10% OFF for siblings registration.

Yes

No

Sibling's Name

Please enter it if registering a sibling

First Name

Last Name

Sibling's Birth Date

Enter it if registering a sibling

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Week(s) attending *

Check the week you'd like your child to participate.

Week 1: June 23 - June 27

Week 2: June 30 - July 03

Week 3: July 07 - July 11

Week 4: July 14 - July 18

Week 5: July 21 - July 25

Week 6: July 28 - Aug 01

Week 7: Aug 04 - Aug 08

Weekday(s) attending $650/Week or $140/Day - 9 AM to 3 PM *

Check one or more days of the week you'd like your child to attend.

Monday

Tuesday

Wednesday

Thursday

Friday

Early Drop-Off at 8AM - $22/day or $100/week *

Yes - Weekly Early Drop-Off at $100/week

Yes - Daily Early Drop-Off at $22/day

No - I don't need this service

Parent/Guardian 1 *

First Name

Last Name

Phone *

(###)

###

####

Parent/Guardian 2 *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact's Name *

First Name

Last Name

Phone *

(###)

###

####

Please read and acknowledge the following: *

I hereby give my approval for my child’s participation in any and all activities (including field trips) prepared by GIRAFAS Play & Learn INC, during the selected classes. In exchange for the acceptance of said child’s candidacy by GIRAFAS Play & Learn INC, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless GIRAFAS Play & Learn INC and all its respective teachers, assistants, and volunteers from any and all liability for any injuries, including damages, losses or fatal injuries sustained by my minor child arising out of traveling to, participating in, or returning from selected camp sessions. I understand that all classes brought to GIRAFAS Play & Learn have been screened and designed for participants in my child’s age group, ensuring their utmost safety.

I have read, understood, and accepted the terms of the above waiver & release of all claims.