Acton Academy Summer Camp Enrollment

STEAM / Entrepreneurship Camp

Enrollment Form
CAMPER INFORMATION
How many campers?
Camper 1 Name
Camper 1 Age
Camper 2 Name
Camper 2 Age
Camper 3 Name
Camper 3 Age
Camper 4 Name
Camper 4 Age
FAMILY INFORMATION
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent's Name

Last NameFirst Name
Parent's Name

Last NameFirst Name
Primary Contact's Cell Number
Format: (000) 000-0000.
Secondary Contact's Cell Number
Format: (000) 000-0000.
Primary Contact's E-mail
example@example.com
Camp Options
Option 1: Full Summer

Full Summer (4 weeks - July 7 to August 1)
How many Full Summer campers?
Full Summer Cost
Option 2: Option by Week
How many "By Week" campers?
ALL DAY CAMP (8:30a - 3:30p)
All Day Weeks
Total Cost of All Day Camps: $
# of weeks * $325
MORNING CAMP (8:30a - 12:30p)
Morning Camp Weeks
Total Cost of Morning Camps: $
Morning Camp Weeks * $225
AFTERNOON CAMP (1p - 4p)
Afternoon Camp Weeks
Total Cost of Afternoon Camps: $
# of weeks * $225
Total of Weekly Camps: $
Medical
Do(es) the camp(ers) have any allergies? If yes, please list them below:
Do(es) the camp(ers) have any previous injuries? If yes, please list them below:
Do(es) the camp(ers) have any current medical conditions? If yes, please list them below:
Do(es) the camp(ers) take any medications? If yes, please list them below:
Other
Is there anything else you feel we should know about the camper(s)?
Disclosures
Medical: I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary. I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment. I confirm that all information given in this form is true, complete, and accurate.
Photo Release: As you know, when your children work on lessons or participate in special events, we often have many great photo opportunities. We would like your permission to use photographs taken during the summer camp to post internally for camp counselor education and as a historical record. Acton Academy Columbus also uses photographs of children for publicity purposes. We promote our summer camp / school using color brochures, our website, and other types of promotional materials. When photographs are used for publicity purposes, children are never identified by name. All photos used for publicity will be available for the child’s parents to review upon request. In addition, parents reserve the right to request that any photograph not be used for publicity. Please sign the permission slip below to indicate your preference for photographs. I understand that my child will not be identified by name when photos are used for publicity purposes. Yes, I do / No, I don't give Acton Academy Columbus Academy permission to use photographs of my child taken during the summer camp.

Other
Payment
Please review our Summer Camp refund policy
TOTAL AMOUNT DUE $
Total cost of camp
Total Amount Due ($)

prevnext( X )
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Payment Methods

Debit or Credit Card

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STEAM / Entrepreneurship Camp

CAMPER INFORMATION

FAMILY INFORMATION

Camp Options

Option 1: Full Summer

Option 2: Option by Week

Medical

Other

Disclosures

Payment

Total Amount Due ($)

Payment Methods