SSSC 2022 Registration Form and Scholarship Application

Camper Information

Scholar's Name *

First Name Last Name

Birth Date *

Month Day Year

Grade *

Gender *

Girl Boy

School

T-Shirt Size *

Registration includes a Stream Scholars hoodie sweatshirt.

Indicate what size you would like to order. (A sample picture of the sweatshirt can be seen on our Stream Scholars brochure.)

Want to order more than one sweatshirt? Email us at sssc@cacaponinstitute.org and we'll be happy to help you!

Sweatshirt Size

Parent/Guardian Information

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State

Zip Code

(OPTIONAL) If this is a SURPRISE gift enrollment, what is the best way to reach you confidentially?

This is not a surprise, my child knows. Email is confidential. Primary phone is confidential. Alternate phone is confidential.

Is this the address where the hoody pack should be sent? *

Yes No

Addressee where hoody should be sent

First Name Last Name

Address where hoody should be sent

Street Address

Street Address Line 2

City State

Zip Code

Main Phone Number *

Alternate Phone Number

E-mail *

Parent/Guardian Permission:

I have reviewed this form and understand that the Stream Scholars Summer Camp will involve supervised activities outdoors, in a classroom setting, and in the water.

As the parent/guardian of the child registering for camp, I give my permission for the child listed above to participate in the Stream Scholars Summer Camp activities. *

I agree

Payment

Full payment of the camp fee is due upon registration. Please see the withdrawal policy below for information regarding refunds.

Scholarship Application

Full scholarship application Partial scholarship application No request

Cacapon Institute encourages scholarship requests. So long as space and funding is available we will provide scholarships. It is our goals to provide an educational experience to every applicant.

Please state your child's interest in camp.

How much can you pay?

To complete your registration, please send a $200 check to:

Cacapon Institute, 10 Rock Ford Road, Great Cacapon, WV 25422

- Please make checks payable to Cacapon Institute with SSSC and the child's name written on the memo line.

- Camp registration will not be considered complete until payment is received. We will send you a camp registration confirmation email upon receipt of your payment.

Camp Withdrawal Policy:

If you withdraw from camp prior to June 25, 2022, you will receive a refund of the camp fee less a $75 non-refundable deposit.

No refunds will be given for withdrawals after June 25, 2022.

Non-Discrimination Policy:

Cacapon Institute does not discriminate on the basis of race, color, national origin, or sex. We strive to be inclusive, regardless of age or disability, and seek a diverse workforce and audience.

Comments:

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Stream Scholars Summer Camp 2022