Summer Learning Camp 23: Registration - Washington Preparatory School

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Camps
Student Life
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About Us

Home Summer Learning Camp 23: Registration

Parent / Guardian Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Camper's Information

Camper's Name(Required)

First Last

Camper's Date of Birth(Required)

MM slash DD slash YYYY

Camper's Grade Entering(Required)

Camp(s) Attending

Week #1:

July 10th - July 14th

AM - Elective Choice

PM - Elective Choice

Week #2:

July 17th - July 21th

AM - Elective Choice

PM - Elective Choice

Week #3:

July 24th - July 28th

AM - Elective Choice

PM - Elective Choice

Week #4:

July 31th - August 4th

AM - Elective Choice

PM - Elective Choice

Emergency Contact Information

Name Relation

Phone

Does your child need to take a prescription or over-the-counter medication during camp hours?(Required)

Yes

No

If yes, please list medications your child will be taking during camp hours.

Will your child be self-administering any of these medications during camp?(Required)

Yes

No

Allergies (please note whether the allergy is an ingested or contact allergy)

Does your child carry an Epi-Pen?(Required)

Yes

No

If yes, what is the allergy?

Dietary Restrictions

Emergency Medical Information

Child’s Physician/ Medical Care Provider & Phone Number

Does your child require any special accommodations?(Required)

Yes

No

If yes, please describe?

Other Information You Think We Should Know

(Relevant information may include: other medical conditions, mobility accommodations, special needs, child’s primary language if not English, etc.)

Authorization for Camp Participation

I authorize my child to participate in the camps listed above. I release Washington Preparatory School from any and all liabilities due to accidents, injury, or other harm to my child.(Required)

Yes

Photo/ Video Release

I grant permission to Washington Preparatory School to use, reproduce, and/or publish for promotion photographs and or film footage taken during camp. The use of these photographs and/or videos is strictly limited for use by the camp organizers. They will not be sold or reproduced for sale in any form.

Yes

No

Authorization to Transport Child

I grant permission to Washington Preparatory School to transport my child in a company Bus or Van, driven by an individual authorized by Washington Preparatory School. (Required for the Sports & Fitness elective.)

Yes

No

Behavior Agreement

I understand that any child exhibiting behavior that may cause harm to themselves, other campers, or camp staff will be asked to leave the program. These behaviors include, but are not limited to, hitting, kicking, biting, sexual harassment, and/or possessing weapons or illegal substances.(Required)

Yes

Summer Learning Camp 23

Total

Payment

Credit Card(Required)

American Express

Discover

MasterCard

Visa

JCB

Maestro

Supported Credit Cards: American Express, Discover, MasterCard, Visa, JCB, Maestro

Card Number

Expiration Date Month Year

Security Code Cardholder Name

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18323 Bothell Everett Hwy Suite 220, Bothell, WA 98012

+1 (425) 892-8669

info@waprep.org