Summer Camp Registration 2023 Parent Name(Required) First Last Email(Required) Second Parent Name First Last Email Select Camp(Required)August 14th - 18th Pioneer HomesteadingJuly 17th - 21st Pioneer HomesteadingIf your child wants to be a junior camp helper (age 13 and up) please call or email us to request this. Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime Phone- best number(Required)Daytime Phone Second Parent best numberPhone- evenings/alternateChild's Name(Required) First Last Child's Age at time of camp:(Required) Second Child's Name First Last Second Child's age at time of camp: Please explain any custody issues we should be aware of:Emergency Contact Person Name:(Required) First Last Their Phone:(Required)Emergency Contact's relationship to child: School your child(ren) attend(s), or mark home schooled:(Required) Dietary Restricions for your child(ren):(Required)Allergies, either known or suspected:(Required)Medications child(ren) will be taking:If this information changes, please notify us before camp begins. We should oversee or administer all medications.Any physical ailments, special needs, or restrictions on activities we should be aware of:(Required)Please let us know anything else we should know for your child to be sucessful in our camps:(Required)Persons Authorized to pick up your child other than parents listed on this form, and their cell phone numbers:Cancellation Policy(Required) I agree to the cancellation policy.Refund/ Cancellation Policy: There is a $30.00 cancellation fee per registration • Up to 14 days before the first day of the program you may cancel your child’s enrollment and receive your money back (minus the $30 cancellation fee). • Cancellations made less than 14 days before the first day of the program will not be refunded. • Registrations and fees are non-transferable.Photography Policy(Required) I agree to the photography policy.Children attending camp may be in photographs/videos of activities happening at camp, taken by camp instructors or other parents, but we will not identify your child by name on our website or in printed materials unless we receive explicit permission from you.Liability Release(Required) I agree to the liability release.We take safety seriously and all staff go through training including safety training. I release Singing Creek Educational Center and its staff, volunteers, and Board Members from any liability resulting from accident or injury to myself or my family members, including children, due to any reason including negligence.Sign this form by typing your name below:(Required) First Last Please pay ONLY the Deposit OR the Full price when registering. DO NOT pay both! Thanks.Deposit Only (we will bill you for the remainder 2 weeks before camp) Quantity Price: $30.00 Quantity Summer Camp Full Price- Put "1" in the Quantity field- Do not pay Deposit if you are paying Full Price. Quantity Price: $230.00 Quantity Siblings Price (Each) Put "2" in the Quantity field. Quantity Price: $200.00 Quantity All siblings must be enrolled in the same camp for the discount. $200 each for both (or all) kids.Coupon Code or Referred By: Donation to our Scholarship Fund for low-income families (optional) Total CAPTCHA
