Summer Camp Request Form

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- DAILY SCHEDULE
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Summer Camp 2025

Student first name*

Student last name*

Enrolling for:*

Regular school day (8am - 2:45pm)

Half day (8am - 12pm)

Optional extended day (2:30pm - 5:30pm)

Date of birth*

Month

Day

Year

Age*

Gender

Street address*

City*

State*

Zip code*

Parent or Guardian 1 name*

Parent or Guardian 1 cell*

Parent or Guardian 1 email address*

Parent or Guardian 2 name*

Parent or Guardian 2 cell*

Parent or Guardian 2 email address*

Secondary home address (if either parent’s home contact is different from child’s)

Session I

Week 1: June 3 - 6

Week 2: June 9 - 13

Week 3: June 16 - 20

Week 4: June 23 - 27

*Closed Thursday, July 19th for Juneteenth

Session II

Week 1: June 30 - July 4

Week 2: July 7-11

Week 3: July 14 - 18

Week 4: July 2 1 - 25

*Closed Friday, July 4th for Independence Day

Does your child have any food allergies?*

Yes

No

If yes, explain:

Is your child allergic to any medication(s)?*

Yes

No

If yes, explain:

Does your child have any medical condition(s)?*

Yes

No

If yes, explain:

Who should we contact in case of emergency?*

Name

Emergency contact 1 cell*

Who should we contact in case of emergency?*

Name

Emergency contact 2 cell*

Emergency Release: In the event of an emergency, I authorize Petite Ecole Internationale to administer First Aid, take my child to a clinic or hospital (or emergency room) or to take any other action necessary. I would prefer that my child be taken to*

Name and address of facility

Parent or Guardian signature*

Date*

Month

Day

Year

Petite École Internationale

831 Springdale Rd

Austin, Texas 78702

512.302.3180

info@petiteecole.com

Photography by Casey Chapman Ross

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