Camp enrollment form | Busy Bee Play Cafe

Child's Full Name

Child's Date of Birth

Child's Age

Known Allergies — write NONE if none

Medical Conditions or Special Needs Staff Should Be Aware Of

Primary Parent/Guardian Full Name

Primary Guardian Relationship to Camper

Primary Parent/Guardian Phone Number

Primary Parent/Guardian Email

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Secondary Emergency Contact Relationship to Child

Authorized Pickup Persons — list full name and phone for each person

Health Insurance Provider

Health Insurance Policy Number

Primary Care Physician Name and Phone

I consent to staff administering the following for minor discomfort or injury (check all that apply)

Band-aids / basic first aid supplies

Cold compress / ice pack

Sunscreen (SPF 30+, provided by BBPC)

Prescribed Medication Disclosure: My child carries a prescribed medication (EpiPen, inhaler, etc.)

If yes, medication and instructions must be provided to staff in a labeled bag on Day 1.

Potty Training Status

Photo/Video Release

I authorize Busy Bee Play Cafe, LLC to photograph and/or video record my child during camp activities for use in marketing materials, social media, website content, and promotional purposes. I understand that no compensation will be provided and that images may be used indefinitely.

Please review and read the following (click to expand):

In exchange for participation in the activity of:

Indoor children's play activities including but not limited to: climbing on soft play structures, sliding, role-play in mini town area, arts and crafts activities, sensory play, active physical play, and general recreational play in a supervised indoor play facility for children ages 0-6.

I, the parent or legal guardian of the child named above, have read and agree to the Busy Bee Play Cafe Summer Camp Drop-Off Waiver & Enrollment Agreement.

I acknowledge that this is a drop-off program and that I assume full responsibility for my child's participation.

I authorize BBPC staff to seek emergency medical treatment for my child if I cannot be reached. I have disclosed all known allergies and medical conditions above.

I understand and agree to the authorized pickup policy and late pickup fee.

I understand and agree to the Busy Bee Play Cafe Summer Camp cancellation and refund policy: Full payment is due at registration. Cancellations made 14 or more days before the first day of camp: 50% of total tuition refunded. Cancellations made 7–13 days before camp: no refund issued. Cancellations fewer than 7 days before camp: no refund issued. If Busy Bee Play Cafe cancels a session, a full credit toward a future session will be issued.

Parent/Guardian Signature

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Parent/Guardian Printed Name

Date

Month

Day

Year

Summer Camp Enrollment Form