Kimber's Reading Express Camp Application

Please indicate which session(s) 

your child will be attending.


  Camp Location: 
   Abundant Life Reformed Church
475 Lafayette Ave
Wyckoff, NJ 07481



 

Dates Attending Camp:_____________________________________


Child's Name:______________________________________________


Parent's name:____________________________________________

  

Address:__________________________________________________

 

__________________________________________________________

 

__________________________________________________________

 

Home Phone:_______________________________________________

  

Cell Phone:_________________________________________________

  

Email:_____________________________________________________


 

School Attending Presently:___________________________________


Current Grade ________________

 

  

How did you hear about the program?________________________________

 

 

Does your child have any allergies? If so , please specify:


__________________________________________________________________

 

___________________________________________________________________

 

 

Emergency  Contacts: (name & phone #)

 

1)_________________________________________________________

 

 2)_________________________________________________________

 



I, _______________________________________________, authorize Kimber's Reading Express  LLC to request medical treatment if unable to reach parent/guardian.

 


I, ______________________________________________________, give my permission to Kimber's Reading Express, LLC to post pictures of my child, __________________________, on Social Media ( i.e. Facebook, Twitter, & Kimber's Website).  I understand that names of the individual will NOT be used.



Signature______________________________________________


Print Name ____________________________________________


Date _________________________________________________

 

50% of tuition is due two weeks prior to the starting date to hold your spot.  The deposit is non-refundable. Missed classes will not be refunded nor pro-rated.

Please mail application to:  Kimber's Reading Express

                                                    P.O. Box 415

                                                    Montville, NJ 07045