Register — Margot Crocker Art

👤 Parent / Guardian Information

First Name *

Last Name *

Email *

Phone *

🚨 Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship *

Secondary Phone

Language Preference

English Spanish Both

🚸 Authorized Pickup Persons

List people authorized to pick up your child(ren). Phone/email changes will not be accepted day-of — only people listed here.

🏥 Medical Treatment Authorization *

In case of medical emergency where the parent cannot be reached:

I authorize treatment at [your specified facility]

Authorize treatment at a different facility:

I do NOT authorize medical treatment for my child

⚠️ I acknowledge that Margot Crocker Art is not responsible for any injury that may occur during the hours of summer camp. *

Margot Crocker Art