2023 Summer Camp Registration Form
at Wittmann Learning Center
Camper's Information
Personal & Health & Contact
Name
First Name
Last Name
Birth Date
January
February
March
April
May
June
July
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October
November
December
Month
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Day
2023
2022
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1920
Year
Age (at time of camp)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18+
Grade (entering this fall)
List Any Allergies and Dietary Restrictions
Will student need to take medications while at camp?
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent / Guardian Information
(All correspondence and and invoices will be sent to this person)
Name
First Name
Last Name
Email
example@example.com
Cell Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Relationship with the Camper
Emergency Contacts and Authorized Pick Up Persons
Program Information
Camp is from 8 am until 3:00 pm. Students may be picked up early if wishing to participate in half day, however, camp fees are not changed. All camps require a $25 registration fee per camp. Each Camp fee is $90 for a total of $115 per week. Registration fee is due upon registration and the remaining balance is due the Friday before camp begins. Limited spacing available for each camp.
Select Camp Week/Theme and Price
The Wizarding World June 5-9, 2023
Superheroes Assemble June 12-16, 2023
Lost In Space June 19-23, 2023
Adventures at Sea June 26-30, 2023
Detective Mystery Week July 3-7, 2023 (4 days Closed July 4)
Enchanted Forest July 10-14, 2023
Camp Olympics July 17-21, 2023
Total Camps Attending
Deposit Invoice will be sent by Square Invoice due within 24 hours in order to secure space.
Credit Card by Square Invoice
My Products
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( X )
Registration Fee per Camp
$
25.00
There is a $25 registration fee per camp you wish to register for.
Quantity
1
2
3
4
5
6
7
8
9
10
Camp T-Shirt
Camp T-Shirts are available at an additional cost. Please indicate quantity next to the size you wish to order. T-Shirt orders are due at time of registration.
Size
Quantity
Price
Youth XS
1
2
3
4
5
6
7
8
9
10
$
15.00
Youth S
1
2
3
4
5
6
7
8
9
10
$
15.00
Youth M
1
2
3
4
5
6
7
8
9
10
$
15.00
Youth L
1
2
3
4
5
6
7
8
9
10
$
15.00
Youth XL
1
2
3
4
5
6
7
8
9
10
$
15.00
Adulth XXL
1
2
3
4
5
6
7
8
9
10
$
16.00
Adult XXXL
1
2
3
4
5
6
7
8
9
10
$
16.00
Adult S
1
2
3
4
5
6
7
8
9
10
$
15.00
Adult M
1
2
3
4
5
6
7
8
9
10
$
15.00
Adult L
1
2
3
4
5
6
7
8
9
10
$
15.00
Adult XL
1
2
3
4
5
6
7
8
9
10
$
15.00
Total
$
0.00
Credit Card
Liability Waiver
I agree to the following LIABILITY WAIVER: The undersigned being the lawful parent and/or guardian of the above child(ren) hereby consent to the participation by the child(ren) in all activities conducted by Wittmann Learning Center and to the participation of the child(ren) in all events related to said activities. The children that participate in activities and adventures with Wittmann Learning Center are consistently well supervised, however, accidents do happen. The undersigned assumes all risk of injury or harm to the child(ren) associated with participation in Wittmann Learning Center's activities and adventures and agrees to release, indemnify, defend, and forever discharge Wittmann Learning Center and its subsidiaries, vendors, staff, employees, and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action in respect of death, injury, loss or damage to the child(ren), howsoever caused, arising by reason of or during the child(ren)'s participation in attendance and activities at Wittmann Learning Center.
Signature: By placing your signature, you understand and agree to the liability waiver above.
Clear
Date
-
Month
-
Day
Year
Date
Signature
Clear
Submit
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