Online Registration Form - Summer Camp

Name - Mother *

Surname - Mother*

Local Phone - Mother*

Date of Birth - Mother*

E-mail Address - Mother*

Name - Father *

Surname - Father*

Local Phone - Father*

Date of Birth - Father*

E-mail Address - Father*

Name of Child*

Surname of Child *

Personal identification number or Passport Number - Child*

Gender - Child*

Permanent Address in Prague - Family*

Date of Birth - Child*

Residence Status - Child*

Nationality - Child*

What languages does your child speak?*

Attendance begins

Does your the child sleep after lunch?*

Daily Routine

Dietary Restrictions

Doctor´s Name, Phone and Address*

Prescriptions Medications

Child´s Blood Type*

Medical Insurance Co.*

Illness or Conditions

Vaccination (immunization)*

Tell us more about your child

How did you hear about us?*