WATW SPRING BREAK CAMPER REGISTRATION

Camp Registration Form

We are excited to kick off spring break with your camper! Please fill out the registration form by February 25, 2025 to reserve your child's spot. We are so excited to see you! As always, siblings are more than welcome to attend with their sibling.
Camper's Information

We understand this form may be lengthy for some, but in order to make this the best experience for our campers there's a wide range of questions to ask. Feel free to skip any optional questions that don't pertain to your family. Thank you for your cooperation.
Camper Name*
Age*
Camp Session Registering For?*
**please select the age group this child will be attending.
Agency Camper Attends*
Allergies? Check all that apply. *
Please list and explain any allergies or dietary restrictions

0/150
Does your child have any vision, hearing, mobility, healthcare, or behavioral needs of which we should be aware? Please be detailed here, your answers help us in making all activities possible for each camper:*

0/150
Many of our campers are new and none verbal, please help us by uploading a clear photo of your child. This photo will only be shared with camp staff or in the event of an emergency. *

Browse Files

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NOTE: We are excited to welcome siblings, ages 3-17, this year to Camp! Please reserve a spot for each child attending by providing the name, age, and session. Have an older sibling (16+) who wants to lend a hand during camp? Please refer to the VOLUNTEER application.
Sibling's Information

**if you don't have any siblings attending, please continue to page 2**
1st Sibling Name
Age
Camp session registering for?
**please select age group this child will be attending.
Allergies? Check all that apply.
Please explain any allergies

0/150
Many of our campers are new or none verbal, please help us by uploading a clear photo of your child. This photo will only be shared with camp staff or in the event of an emergency.

Browse Files

Cancelof
2nd Sibling Name
Age
Camp session registering for?
**please select age group this child will be attending.
Allergies? Check all that apply.
Please explain any allergies

0/150
Many of our campers are new or none verbal, please help us by uploading a clear photo of your child. This photo will only be shared with camp staff or in the event of an emergency.

Browse Files

Cancelof
3rd Sibling Name
Age
Camp session registering for?
**please select age group this child will be attending.
Allergies? Check all that apply.
Please explain any allergies

0/150
Many of our campers are new or none verbal, please help us by uploading a clear photo of your child. This photo will only be shared with camp staff or in the event of an emergency.

Browse Files

Cancelof

Parents' Information
Parent/Guardian*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Parent/Guardian

*if applicable
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
Cell Phone

Emergency Contacts

Parents cannot be listed as emergency contacts. Please list the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. This person must be able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact Information
Full Name*

First NameLast Name
Primary Phone Number*
Relationship to Child*

Medical / Health Information
Name of Physician or Clinic/Hospital*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
In the case of an emergency, do you give WE ARE THE WORLD DAY CAMP staff permission to seek immediate medical attention?*

YesNo
Please list all known medical conditions and/or diagnosis your child may have. Be as specific as possible so that we will be able to help make your child's camp enjoyable!

0/150
How would you like us to handle the situation in the event of an medical episode?

0/150
List any additional information about your child that would be useful for staff to know, such as fears, eating habits, or toileting needs. This information should not be medical, as that information should be included in the previous question.

0/200

NOTE: We are excited to welcome siblings, ages 3-17, this year to Camp! Please reserve a spot for each child attending by providing the name, age, and session. Have an older sibling (16+) who wants to lend a hand during camp? Please refer to the VOLUNTEER application.
Behavior Agreement
The staff of WATW camp want to ensure your child's camp experience is as enjoyable as possible. To make that happen we need to confirm every child is able to follow the following criteria:

1. Keep hands to self

2. Follow simple instruction

3. Sit/Stay with the group

4. Share and take turns with peers

If behaviors arise during the camp, the following hierarchy of intervention will be used:

1. Reinforce appropriate behavior

2. Extinction (ignoring the behavior and withholding reinforcement)

3. Verbal prompt to discontinue the behavior

4. Request to leave the area and take a break

5. Parent phone call

6. Removal for the day

7. If the behavior continues the following day, remove from the camp for the current session.

We understand that every child will exhibit behavior, and that is okay and expected. If your child has a specific behavior modification plan, or your child is highly reinforced by something, please let us know.
I agree to this behavior intervention plan and will adhere to it if my child demonstrates behavior during the session. I agree to discuss the behavior expectations with my child prior to the start of camp, so that he/she will be prepared to make "good choices".

Publicity Release for We Are The World Day Camp
I give my permission to the staff of WATW Camp to utilize photographs taken by staff for the purpose of: Staff training and publicity materials to include but not limited to brochures, slideshows, newsletters, thank you ads, website and social media advertisements:*

Yes, I give my permission to have my child's photograph taken and used to support the mission of We Are The World Day Camp.I do not want my child’s photograph to be taken or used in any publicity by We Are The World Camp.
I agree that I have completed this form to the best of my ability.*

YesNo
Sign Document*
Date Signed*

MonthDayYear
For any questions, please contact Tawny Zachary, camp director at 806-831-5327 or wearetheworlddaycamp@gmail.com
Should be Empty:

Camp Registration Form

Camper's Information

Sibling's Information

Parents' Information

Additional Parent/Guardian

Emergency Contacts

Emergency Contact Information

Medical / Health Information

Behavior Agreement

Publicity Release for We Are The World Day Camp