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Camp Veranito
Copiosa
Copiosa
Los Amiguitos
ABOUT US
OUR PROGRAMS
Los Amiguitos
Kinder Amigos
Copiosa
PARENT'S CORNER
CONTACT US
(412) 977- 0941
contact@clippgh.com
Learning today. Engaging tomorrow.
Camp Veranito Registration Form
Student(s) Information
Student 1 Last Name
First Name
School
Grade
(in the fall)
Date of Birth
Food allergies (leave blank if none)
Non food allergies (leave blank if none)
Allergy meds (leave blank if none)
Gender
Any other medical or non medical concerns we should know about
Student full street addres (including city and zip code)
Student 2 Last Name
First Name
School
Grade
(in the fall)
Date of Birth
Food allergies
Non food allergies (leave blank if none)
Allergy meds (leave blank if none)
Gender
Any other medical or non medical concerns we should know about
Student 2 street addres (only fill out if different than student 1)
Student 3 Last Name
First Name
School
Grade
(in the fall)
Date of Birth
Food allergies (leave blank if none)
Non food allergies (leave blank if none)
Allergy meds (leave blank if none)
Gender
Any other medical or non medical concerns we should know about
Student 3 street addres (only fill out if different than student 1)
Parent/Guardian Information
Parent/Guardian's Full Name
Relationship to Student(s)
Email
Phone number
Parent/Guardian's 2 Full Name
Relationship to Student(s)
Email
Phone number
People Authorized to Pick up your Student(s)
Authorized Pick up Person Full Name 1
Relationship to Student(s)
Email
Phone number
Authorized Pick up Person Full Name 2
Relationship to Student(s)
Email
Phone number
Emergency Contacts
Emergency Contact Full Name 1
Relationship to Student(s)
Email
Phone number
Emergency Contact Full Name 2
Relationship to Student(s)
Email
Phone number
I want to receive the latest CLIP news
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