1st Child’s D.O.B * 2nd Child’s D.O.B 3rd Child’s D.O.B Select Week *Week 1: 24 Jun - 27 JunWeek 2: 1 Jul - 4 JulWeek 3: 8 Jul - 11 JulWeek 4: 15 Jul - 18 JulWeek 5: 22 Jul - 25 JulWeek 6: 29 Jul - 1 AugWeek 7: 5 Aug - 8 AugWeek 8: 12 Aug - 15 AugWeek 9: 19 Aug - 22 AugWeek 10: 26 Aug - 29 Aug Food Preferred *VegNon Veg Water Activities Permission *Give PermissionDo Not give Permission Child Swimming Skill *No SwimNoviceLightModerateStrong Child Pictures for Publication *Grant PermissionDo Not Grant Permission Health Conditions: Respiratory Problem *YesNo Diabetes *YesNo Hypoglycemia *YesNo Dizziness *YesNo Seizures *YesNo Physical Problems *YesNo Other Conditions *YesNo Does your Child use EpiPen for Allergy *YesNo
