2025 SUMMER CAMP Register Registration form What program are you registering to? Summer Camp Ramadan Camp Daycare Little Seeds 0 - 18 Month Infants Blooming Blossoms 3 - 5 Years old Parent/Guardian Information * First Name Last Name Relationship to Child * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Child's Name * First Name Last Name Date of Birth * MM DD YYYY Gender * Male Female Emergency Contact Information * First Name Last Name Relationship to Child * Primary Phone Number (###) ### #### Medical Information Pediatrician's Information First Name Last Name Pediatrician's Phone Number (###) ### #### Does your child have any allergies? * Yes No Does your child have any medical conditions or require any medications? * Yes No Authorized Pick-Up Persons (List any additional individuals authorized to pick up your child. Please provide full name, and contact number.) When would you like your child to start? MM DD YYYY How did you hear about us? Social Media Community Center (HAWA) From a Friend Event Open House Other Consent & Agreement * I, the undersigned, give permission for my child to participate in the daycare program and authorize the staff to administer necessary first aid and seek emergency medical treatment when needed. While every precaution is taken to ensure a safe environment, I understand that unforeseen incidents may occur. In enrolling my child, I assume these risks and release the daycare from liability for any injuries or accidents. Yes I confirm that the information provided is accurate and complete * Yes Pictures Consent * I consent to the use of photographs and videos of my child taken during the program for promotional and archival purposes. Yes No Anything else you’d like to share or ask? Thank you for registering your child with Karaz Kidz! We’re excited to be part of this journey and hope it will be a wonderful step for your child to shine and grow.