Windmore's Fine Arts Summer Camp Registration 1st Session

Welcome to Windmore's Fine Arts Summer Camp. Our week-long camps will encourage and empower kids to explore a variety of art disciplines!

Amanda Reck is the director of the camp. If you have questions or concerns, she can be contacted at summercamp@windmorefoundation.org

1st Session: Monday, June 14th thru Friday, June 18th

Hours: 9:00 AM to 2:00 PM
Ages: 6-12
Location: 303 South Main Street, Culpeper, VA
CDC Limitations: Each session limited to 10 campers Cost: $150 per session per child

Remember: The Sibling discount is only available after the first child is Paid-in-Full

Scholarships available

IMPORTANT: A non-refundable deposit of $75 is required at the time of registration and the remaining balance is due on the first day of camp.

REFUND POLICY

To receive a credit for another program or workshop, you must email summercamp@windmorefoundation.org 48 hours before the first day of camp. The registration deposit is non-refundable.

Camper Information

Camper's Name *

First Name Last Name

Birth Date *

Month Day Year

Grade entering Fall 2021

Gender

Male Female

Parent/Guardian Information

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Main Phone Number *

E-mail *

T-Shirt *

Child's T-Shirt Size Small Child's T-Shirt Size Medium Child's T-Shirt Size Large Adult T-Shirt Size Small Adult T-Shirt Size Medium Adult T-Shirt Size Large Adult T-Shirt Size Extra Large

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship

Emergency Contact's Main Phone Number *

Does the Camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler? If yes, please explain any instructions.

Other Medical Information

Doctor's Name *

First Name Last Name

Doctor's Phone Number *

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Windmore Foundation for the Arts during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Windmore Foundation for the Arts. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against The Windmore Foundation for the Arts including all counselors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all physical activities.

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Windmore Foundation for the Arts and its affiliates including Directors, Counselors, and Volunteer Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered camp.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Cancellation Acknowledgement/Refund Policy

Please note: This written cancellation policy is always binding.

NO verbal communication from Windmore Foundation of the Arts board members/staff/volunteers can override the written policy.
All cancellation refund requests must be submitted by email, NO EXCEPTIONS.
No refunds are given for any missed/sick days.
Campers asked to withdraw from camp for Camper Code of Conduct violations will receive no refund.

REFUND POLICY

To receive a credit for another program or workshop you must email us 48 hours before the first day of camp at summercamp@windmorefoundation.org

Liability Forms

Click this link to download the State Climb waiver. Bring the completed form to the first day of camp.

Media Release

I, the undersigned parent/guardian, do hereby consent and agree that the Fine Arts Summer Camp and Windmore Foundation for the Arts, its employees, or agents have the right to take photographs, videotape, or digital recordings of my child and to use these in any and all media, now or hereafter known, and exclusively for the purpose of publicity & historical documentation. I further consent that my child’s name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to the Fine Arts Summer Camp and Windmore Foundations for the Arts, its agents, and employees all rights to exhibit this work in print and electronic form, publicly or privately, and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my child’s identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording my child, either for initial or subsequent transmission or playback.

I also understand that Fine Art Summer Camp and Windmore Foundation for the Arts are not responsible for any expense or liability incurred as a result of my child’s participation in this recording, including medical expenses due to any sickness or injury incurred as a result.

Media Consent: Select only ONE option. *

Agree Disagree Approve but use only first name, last name initial

MULTIPLE REGISTRATIONS IN ONE FAMILY:

Sibling discount of $25 after 1st child’s tuition ($150) is paid in full. *Discount does NOT apply towards the first child’s registration.

Select One of the Payment Options *

Registration Fee $ 75.00

Payment in Full $ 150.00

Total $ 0.00

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Use mouse, graphics tablet or touch screen to create your signature. *

Clear

Are you registering a sibling? *

Yes No

If you are registering a sibling, after you submit the Payment-in-Full, you will see "Return to Merchant." Click on Return to Merchant and you should be redirected to the new sibling registration.

Session

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The Windmore summer camp is partially funded by a grant from The Culpeper Foundation Fund from Northern Piedmont Community Foundation.

Summer Camp First Session Registration