Camp Rikud - Woodlands Community Temple

Name of person filling out registration

Are you a Woodlands Community Temple member?

How many children are you enrolling in Camp Rikud?

Child's Information

Child's Full Name

Age

Does your child have any previous tap dance training? If yes, please explain:

Does your child have tap shoes?

Please note that participants are not required to have tap shoes; however, they are helpful in making the tap sounds

Please tell us about any medical, mental health, or allergy diagnoses that may impact your child during camp.

This could include allergies to medicine, food, or environment, asthma, anxiety, OCD, dietary restrictions, or other mental or physical health issues.

* I give WCT permission to administer basic over the counter medications to my child.

* I give WCT permission to administer First Aid/CPR to my child.

Is there anyone who is NOT allowed to pick up your child?

Is there anything you would like to share with us?

Woodlands Community Temple takes pictures to document our experience and to share them with the WCT community in emails, on the website and on social media. If you would not like your child(ren)'s photograph to be shared, please email wct@wct.org.

Child 1's Information

* Child's Full Name

Age

Does your child have any previous tap dance training? If yes, please explain:

Does your child have tap shoes? (Please note that participants are not required to have tap shoes; however, they are helpful in making the tap sounds.)

Please tell us about any medical, mental health, or allergy diagnoses that may impact your child during camp.

This could include allergies to medicine, food, or environment, asthma, anxiety, OCD, dietary restrictions, or other mental or physical health issues.

* I give WCT permission to administer basic over the counter medications to my child

I give WCT permission to administer First Aid/CPR to my child.

Is there anyone who is NOT allowed to pick up your child?

Is there anything you would like to share with us?

Child 2's Information

Child's Full Name

Does your child have any previous tap dance training? If yes, please explain:

Age

Does your child have tap shoes? (Please note that participants are not required to have tap shoes; however, they are helpful in making the tap sounds.)

Please tell us about any medical, mental health, or allergy diagnoses that may impact your child during camp.

This could include allergies to medicine, food, or environment, asthma, anxiety, OCD, dietary restrictions, or other mental or physical health issues.

* I give WCT permission to administer basic over the counter medications to my child

I give WCT permission to administer First Aid/CPR to my child.

Is there anyone who is NOT allowed to pick up your child?

Is there anything you would like to share with us:

Child 3's Information

* Child's Full Name

Age

Does your child have any previous tap dance training? If yes, please explain

Does your child have tap shoes? (Please note that participants are not required to have tap shoes; however, they are helpful in making the tap sounds.)

Please tell us about any medical, mental health, or allergy diagnoses that may impact your child during camp.

This could include allergies to medicine, food, or environment, asthma, anxiety, OCD, dietary restrictions, or other mental or physical health issues.

* I give WCT permission to administer basic over the counter medications to my child

I give WCT permission to administer First Aid/CPR to my child.

Is there anything you would like to share with us:

Is there anyone who is NOT allowed to pick up your child?

Child 4's Information

* Child's Full Name

Age

Does your child have any previous tap dance training? If yes, please explain:

Does your child have tap shoes? (Please note that participants are not required to have tap shoes; however, they are helpful in making the tap sounds.)

Please tell us about any medical, mental health, or allergy diagnoses that may impact your child during camp.

This could include allergies to medicine, food, or environment, asthma, anxiety, OCD, dietary restrictions, or other mental or physical health issues.

I give WCT permission to administer basic over the counter medications to my child

I give WCT permission to administer First Aid/CPR to my child.

Is there anyone who is NOT allowed to pick up your child?

Is there anything you would like to share with us?

Adult 1 Information

* Full Name

* Cell Phone

Address

City

State

Zip Code

Adult 2 Information (if applicable)

Full Name

Cell Phone

Emergency Contact

* Full Name

* Email

* Cell Phone

* Relationship to Child

Total Due