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Interconnected World Summer Camp 2020

Sessions (Check all that apply)*
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Half Day Camp
Full Day Camp
After Care Camp(Whole Week)
Aug 3- Aug 7 Magical Creatures
Aug 10 - Aug 14 Farm to Table Chinese Cuisine

STUDENT INFORMATION

Gender*
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Primary language spoken at home*
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Grade*
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State*
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PARENT/LEGAL GUARDIAN INFORMATION (#1)

Home Address (if different from student's)

State
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PARENT/LEGAL GUARDIAN INFORMATION (#2)

EMERGENCY CONTACT

All families are required to supply NWCA with a secondary emergency contact in the event that a child’s parents/primary guardian cannot be reached. I understand and agree that this emergency contact will be authorized to make decisions in case of emergency, serious illness or accident involving my child.*
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MEDICAL INFORMATION

If your child requires medicine during school hours, please complete and submit a NWCA Medication Form (available from the school office) and supply the following information and documents to the school:

● The physician’s or parent’s orders

● The medicine in its original container with the label attached

● Complete and clear written instructions of the type of medicine, dosage, and time/s and date/s to be administered. (Prescription medicine will already have the health provider’s instructions on the pharmacy label as per Oregon statutes.)

PAYMENT METHODS*
*Payments by check or money order should be mailed to: Northwest Chinese Academy 16860 SW Blanton St, Aloha, Oregon 97078
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How did you hear about us?*
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Applications received with insufficient funds to cover the application deposit are not processed until a full deposit is received.*
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Confirmation Email