Register For Summer Camp

Date of Birth(Required)

Parent's Names(Required)

Parent 1 Work

Parent 1 Cell(Required)

Parent 1 Email(Required)

Parent 2 Work

Parent 2 Cell

Parent 2 Email

Previous school, camp, or daycare experience

Allergies or other significant medical condition(Required)

Potomac

St. D's/Bethesda

Rockville

Session Dates

Emergency Contact Information

Emergency Contact(Required)

A parent or Legal Guardian

Phone(Required)

2 Emergency Contact

A parent or Legal Guardian

Phone

Primary Care Physician or other provider of medical care(Required)

Phone(Required)

Health Information

Explain

IMMUNIZATION INFORMATION

Must list current residence above

Explain

Outside of US Record of Vaccination or Immunity

For campers who reside outside the United States, a United States territory, or the District of Columbia: Attach record of vaccination or immunity on Department form MDH-896 *Please note: fI your child has an allergy or takes medication, we will need an allergy action plan and medication authorization form prior to their attendance at camp.*

Max. file size: 50 MB.

For campers who reside outside the United States, a United States territory, or the District of Columnia: Attach record of vaccincation or immunity on Department form MDH-896.

*Please note: if your child has an allergy or takes medication, we will need a allergy action plan and medication authorization form prior to their attendance to camp.*

Summer Camp Deposit

Price:

Total

Credit Card

Card Details

Cardholder Name

Maryland’s First Montessori School in Potomac, Bethesda, and Rockville.

Summer Day Camp