IMG-20170617-WA0000 IMG-20170617-WA0001 IMG-20170617-WA0002 IMG-20170617-WA0003 IMG-20170617-WA0004 IMG-20170617-WA0005 IMG-20170617-WA0006 IMG-20170617-WA0007 IMG-20170617-WA0008 IMG-20170617-WA0009 IMG-20170617-WA0010 IMG-20170617-WA0011 SUMMER FOOTBALL CAMP REGISTRATION FORM Student's Name First Last AgeSexFemaleMaleClassMother's Name First Last Father's Name First Last Mother's Phone NumberFather's Phone NumberParent's Email Kits sizeSmallMediumLargePerson Authorized to pick the childChild's AllergiesAny health issuesYesNoIf yes, please specifyIs your child on any medicationDo we have your permission, in the event of an emergency to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat your child as they may deem advisable.YesNoDoctor's ContactParent’s consent Spring Meadow Edutainment has authorization, in the event of an emergency and in case I am not reachable, to authorize any medical personnel to attend or treat my child as deem advisable. Authorization I authorize Spring Meadow Edutainment to use my child’s photograph/video recording (individually or in group) for educational or promotional purpose. Agreement By checking this box, you attest that the information contained in this form is correct and you agree to comply with the policies and fee statement. Date PAYMENTRegistration Fee is N55,000. This includes Branded Kits and Daily lunch. For electronic transfers, please find below the account information. Account name: Spring Meadow Limited Account number: 0013729058, Stanbic IBTC Bank Alternatively payments can be made at the Accounts Department Accommodation Yes No The registration fee for residential is N90,000 which includes the Camp fee, Kits, Breakfast, Lunch and Dinner. Please upload prove of payment here.