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BEST PREP SUMMER CAMP 2025

ENROLLMENT FORM FOR PS 163Q

Student Information

Student Last Name*

Student First Name*

Birthday*

Month

Day

Year

Sex*

Male

Female

Grade to be in September*

K

1st

2nd

3rd

4th

5th

Attending school*

My child is...

New to Best Prep

Returning to Best Prep

Home Address*

Guardian Information

Guardian 1 Information

Guardian 1 Full Name*

Relationship to child*

Guardian 1 Email*

Phone

Guardian 2 Information (Optional)

Guardian 2 Full Name

Relationship to child

Guardian 2 Email

Guardian 2 Phone

Emergency Contact Information

Emergency Contact Full Name*

In the case of an emergency when primary contact cannot be reached.

Emergency Contact Phone*

Emergency contact address*

Program Detail

Program Selection*

Full Day 8:00 - 3:00 ($1,800)

Extended Day 8:00 - 5:00 ($2,100)

Payment Method*

Check

Zelle

Credit card (3.837% fee)

Cash (in person)

ACS Voucher

How did you hear about us?*

Our website

School flier

Referral

Other

Preferred Language

Dismissal Information

My child may be picked up by the following person(s)*

My child may NOT be picked up by the following person(s)*

Please mark as "NA" if inapplicable

Student Health Information

Please check all that applies to your child*

Asthma

Behavioral/ Emotional Issues

Convulsions/ Seizures

Corrective devices (glasses, hearing aid, etc.)

None of the above

Other

Does your child take medication for any condition or illness?*

Please mark as "NA" if inapplicable

Are there any activities your child can NOT participate in? (Mark NA if not applicable)Are there any activities your child can NOT participate in?*

Please mark as "NA" if inapplicable

Does your child have any allergies?*

Please mark as "NA" if inapplicable

For children who need Epinephrine auto-injector and/or inhaler on site only:

I allow my child to carry his/her epi-pen and/ or inhaler.

(Signature required - please type your name)

Program Policy

Best Prep Policy

I have read the "Policy" (above) and understood the terms and conditions.

Is there anything else you would like us to know?

Please review all information to make sure everything is accurate
Please note registration is not finalized until payment is received
A representative will be in contact with you via email within 1-2 business days from receiving your application.

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