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Children’s Program Registration
Please complete this form for
each
child that will be attending.
1.
Name of the child
2.
Child’s birth date
3.
Child’s first language
4.
Child’s allergies
5.
Dietary needs
6.
T-shirt size
7.
Parent/Guardian Name
8.
Parent/Guardian e-mail
9.
Parent/Guardian phone number
10.
Please select whether your child is able to enter the water during swimming activities:
Kiddie Pool
Shallow Pool
Water slide area
Deep Pool
11.
What is your child’s swimming level?
12.
Please select the days your child will be attending:
Tuesday, August 18, 2:00 pm–4:00 pm
Tuesday, August 18, 6:30 pm–8:30 pm
Wednesday, August 19, 9:00 am–5:00 pm
Thursday, August 20, 9:00 am–1:00 pm
13.
Photo and video authorization:
The Atlantic Summer Institute on Healthy and Safe Communities may take photos and videos of my child during the event and may use the images for promotional purposes, as well as in a presentation show to attendees at the end of the Symposium.
Agree
Disagree.
14.
Please let us know if there is anything we should be aware of that could help us make the experience more enjoyable, support better participation, or enhance the overall program experience.
More details about the program will be shared soon. If you have any questions, please contact the Children’s Program Coordinator, Cristina Morales, at cristinamorales19@hotmail.com
