Please enable JavaScript in your browser to complete this form.Registration formBlossom Heights Legacy Summer Camp Registration FormChild's Name *FirstLastDate of Birth (dd-mm-yyyy) *Gender *MaleFemaleAddress *Start Date (dd-mm-yyyy) *1. Parent/Guardian *FirstLastRelationship to Child *Address *Work Phone *Cell Phone *Home phone *Email *2. Parent/GuardianFirstLastRelationship to ChildAddressWork PhoneCell PhoneHome phoneEmail3. Emergency Contact Person (Other than Parents/Guardians), can also pick up the child *FirstLastRelationship to Child *Address *Work PhoneCell Phone *Home phoneEmail 4. Emergency Contact Person (Other than Parents/Guardians), can also pick up the child FirstLastRelationship to ChildAddressCell PhoneEmail4. Who else is allowed to pick up your Child other than parents/guardian (Name, Address, Phone)? *5. State any Allergies? *6. Is your child's immunization up to date? *YesNo7. Is your child on special medication? *NoYes8. If 7 above is 'yes', please explain *9. What else do we need to know about your child?Choice of Summer Camp class *MorningAfternoonAll DayHow did you hear of Blossom HeightsFlyers in MailFacebookInstagramGoogle searchTwitterPosters in the CommunityA parent in the Centre told meMy friend in the community told meSignature (Please type your name and the date) *MessageSubmit