Fill out this form and Send your Check to Bridges 916 Western Ave Albany, NY 12203

Child(ren) Name *
Child(ren) Name
Street, Apt, City, State, Zip
M/F *
Can write "Same"
Medical Form Required
Does your Child have any known allergies to food? *
Does your child have any known allergies to inects? *
Is it necessary to have medications stored (including Epi-pens, inhalers, etc) ? *
If Yes Director will give you an additional medical form upon arrival
Does your child have a chronic physical, behavioral, or emotional condition expected to last longer than 6 months that requires medication or specialized planning (ADHD, Autism Spectrum, Asthma, Seizure Disorder, etc.) *
May staff apply sunscreen to your child if necessary? (Provided by parent) *
May staff apply bug spray to your child if necessary? (Provided by parent) *
Please fill in your name-forms will be verified upon arrival with physical signature
Registration for: *
Call for Daily Drop in Rates 845-559-3794 for Camp/Afterschool Send Check Written for Bridges at 916 Western Ave Albany, NY 12203

BRIDGES AFTERSCHOOL PROGRAM