Camp registrationoluwafunmilayoilori_r04yldd82019-07-09T18:01:07+00:00 Camper’s Personal DetailsFull Name* First Last Date Of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Address*School*Please select your preference*Day Camper 7am - 6pmBoarding CamperVenue*iRead Library Hub, MarylandMedical DetailsAny Allergies*YESNOAny Medical Condition*YESNODetailsMedication(s)Contact Name in Case of EmergencyPhoneParents/Guardian’s DetailsName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Address* Street Address Email Address* Phone*Office AddressInformed Consent and AcknowledgementInformed Consent and Acknowledgement*AgreeDisagreeI hereby give my approval for my child’s participation in iRead Summer Reading Camp (Day/Boarding). Also, to be involved in any and all activities prepared during the camp. In case of injury to said child, I hereby waive all claims against Funmivirtuous Educational Consult Limited knowing fully well that there is a risk of being injured that is inherent in all activities. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.