Summer at Heights

Nombre del contacto principal

Apellido del contacto principal

Teléfono (Celular)

Dirección

Ciudad

País

Provincia

Código Postal

Dirección de correo electrónico

Contraseña:

My child is subject to the following health issues

Please list all known allergies for this participant

Indicate Agreement
(Required)

Yes
No

I understand that SUMMER AT HEIGHTS accepts NO RESPONSIBILITY FOR MEDICAL LIABILITY. I will be billed for any medical expenses incurred
(Required)

Yes. I read and understand the Medical Liability statement

Indicate agreement
(Required)

Yes
No

Physician's Name

Physician's Telephone Number

The following items are in progress.