Victoria Urban Outreach Tutoring Service 

VUOTS Summer Enrichment Registration 

Once you submit this form and pay the registration Fee you Child(s) Space will be held.  

Parent/Guardian 1*
Parent /Guardian 2
Person 1 Person 2 Person 3
Hospital Preference *
If so where?
Is your child(s) currently being treated for any injuries or sickness*
If yes, please explain
Is your Child(s) allergic to any medications or food *
If yes, please explain
Does your Child require a special diet*
If yes, please explain
Contact 1 Contact 2 Contact 3
Parent/Gaurdian please initial and date
I hereby give my permission for my child to be photographed during VUOTS Summer Enrichment Program. I understand the phone will reused to keep wa journal of activities, to share during power point presentation, candor reports to our donors and for promotional purposes including flyers, brochures, newspaper and our website/internet. I understand that although my Child's photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation. Lastly you acknowledge the that all the photo taken are property of VUOTS.
I hereby give permission for the transportation of my child for official VUOTS activities by modes of transportation agreed to by the program director
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Pay Registration Fee