2024 Summer Camp Form - Casa Italia Chicago

Parent/Guardian Information

First Name *

Last Name *

Relationship *

Email Address *

Phone Number *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Emergency Contact Information

Contact 1: First & Last Name *

Contact 1: Relationship *

Contact 1: Cell Phone *

Contact 1: Email Address *

Contact 2: First & Last Name *

Contact 2: Relationship *

Contact 2: Cell Phone *

Contact 2: Email Address *

Student Information

Number of Students *One | $475Two | $910 ($455-each)Three | $1,365 ($455-each)Four | $1,820 ($455-each)

Student 1

Student 1: First Name *

Student 1: Last Name *

Student 1: Shirt Size *

Student 1: Additional T-Shirt (Optional - $15)

Student 1: Date of Birth *

Student 1: Current Grade *0 / 50

Student 1: Allergies and Medical Conditions

Does {name-5} (Student 1) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.

Student 1: Allergies *YesNo

Student 1: Allergy Description0 / 180

Student 1: Medical Issue? *YesNo

Student 1: Medical Condition Info.0 / 180

Student 1: Notes0 / 180

Student 2

Student 2: First Name *

Student 2: Last Name *

Student 2: Shirt Size *One shirt is included in camp fee

Student 2: Additional T-Shirt (Optional - $15)One shirt is included in camp fee

Student 2: Date of Birth *

Student 2: Current Grade *0 / 50

Student 2: Allergies and Medical Conditions

Does {name-9} (Student 2) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.

Student 2: Allergies *YesNo

Student 2: Allergy Description0 / 180

Student 2: Medical Issue? *YesNo

Student 2: Medical Condition List0 / 180

Student 2: Notes0 / 180

Student 3

Student 3: First Name *

Student 3: Last Name *

Student 3: Shirt Size *

Student 3: Additional T-Shirt (Optional - $15)

Student 3: Date of Birth *

Student 3: Current Grade *0 / 50

Student 3: Allergies and Medical Conditions

Does {name-13} (Student 3) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.

Student 3: Allergies *YesNo

Student 3: Allergy Description0 / 180

Student 3: Medical Issue? *YesNo

Student 3: Medical Condition List0 / 180

Student 3: Notes0 / 180

Student 4

Student 4: First Name *

Student 4: Last Name *

Student 4: Shirt Size *

Student 4: Additional T-Shirt (Optional - $15)

Student 4: Date of Birth *

Student 4: Current Grade *0 / 50

Student 4: Allergies and Medical Conditions

Does {name-8} (Student 4) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.

Student 4: Allergies *YesNo

Student 4: Allergy Description0 / 180

Student 4: Medical Issue? *YesNo

Student 4: Medical Condition List0 / 180

Student 4: Notes0 / 180

PHOTOS: If any photos are taken of your child(ren) participating in our Summer Camp, do you allow Casa Italia, Inc, DBA Italian Cultural Center, to use photos for promotional reasons? * I Allow Casa Italia To Take Pictures Of My Child(ren) For Promotional Reasons.No

REFUND POLICY: 50% of your camp cost will be refunded if cancelled before June 1. After June 1, there are no refunds, except for medical emergencies. We must receive prompt, written notice from a qualified physician verifying the camper's injury or illness for the week of camp for which they wish to cancel. Children that are sent home for inappropriate behavior or homesickness are not eligible for a refund. Casa Italia reserves the right to make all final decisions and changes to this policy. To cancel or change your camper registration, you may call 708-345-5933 or email your request to info@casaitaliachicago.org. *

I have read and understand the Cancellation Policy. If you have questions call 708-345-5933.

TOTAL

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