MP&MS Summer Camp 2022 Registration Form

Registration Form

Summer 2023
Thank you for your interest in Marin Primary & Middle School Summer Camp! Marin Primary & Middle School’s day camp is a magical time for children. We provide a safe, nurturing, and fun environment in which children can make new friends, enjoy activities, create works of art, learn new things, and experience age-appropriate independence.

Campers will enjoy:

    • arts and crafts

    • singing, dancing, and skits

    • games

    • stories

    • science activities

    • nature walks

    • time outside on our beautiful campus

    • and much more!

Children will spend time playing and learning with their friends while participating in a great camp program designed to keep them moving, laughing, and enjoying the summer - safely!

For more than twenty years, Marin Primary & Middle School’s summer programs have enabled campers to augment their academic, physical, social, and emotional growth while having lots of fun with their friends in a comfortable, creative atmosphere. Professional, personable, and experienced staff, many of whom are school-year teachers, lead the program.

MP&MS offers your child a summer experience that’s safe, stimulating, and fun! Please note that we will be closely following all current COVID-19 health and safety guidelines in accordance with Public Health.

Please complete this Registration Form to reserve your campers spot!

Session 1

Session 2

Session 3

June 26-July 7

(7/3+7/4 off)

July 10-July 21

July 24-August 4

Half Day: $745

Full Day: $945

Half Day: $880

Full Day: $1125

Half Day: $880

Full Day: $1125

*These are Early Bird prices reflecting the 10% discount available until 3/31/2023.

Half Day	Full Day
8:30-12:30	8:30-3:30

*MP&MS Summer Camp is for children 2 years old (by June 1) to entering 2nd grade.

Questions? Please contact us at summercamp@mpms.org.

****Session 2 & 3 are FULL for campers between ages 2-3 years.****
Aftercare!
New this summer! We would love to be able to offer Aftercare to our campers!

If you are interested in your camper attending Aftercare, please complete this form to indicate your desired schedule.

We must have a minimum of 10 campers daily to be able to offer this extension of our program. The hours are 3:30-5:30 pm. The rate for Aftercare is $40 per day, per camper.

If we meet the minimum demand, you will receive confirmation and be billed separately.
Email
example@example.com
Kids Night Out!
Join us for KIDS NIGHT OUT!

Campers will enjoy a fun movie and pizza!

Come dressed in cozy pajamas and bring your favorite stuffies and blankets!

July 14 & 28

5:30 - 8:30 pm

$75 per camper per night, $100 per 2 sibling campers per night.

Add one or both nights to your registration below.

Camper Information
Camper's Name:*

First NameLast Name
Camper's Date of Birth:*

MonthDayYear
Date
****Session 2 & 3 are FULL for campers between ages 2-3 years.****
Camper's Age:*
*MP&MS Summer Camp is for children 2 years old (by June 1) to entering second grade.
Has your camper attended camp at MP&MS before?*

YesNo

Parent/Guardian Information
Parent/Guardian Name:*

First NameLast Name
Email:*
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.
Alternate Phone Number:
Please enter a valid phone number.
Secondary Parent/Guardian Information

This section is optional.
Parent/Guardian Name:

First NameLast Name
Email:
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Alternate Phone Number:
Please enter a valid phone number.

****Session 2 & 3 are FULL for campers between ages 2-3 years.****
Other Contacts and Medical Information

Authorized Pick-up Information

The people listed below have your permission to pick-up your camper from MP&MS.

	First and Last Name	Phone Number	Relationship to Camper
Authorized Pick-up 1
Authorized Pick-up 2
Authorized Pick-up 3

Emergency Contacts
In case of emergency, we will reach out to the above-listed parents or guardians. In the event you cannot be reached, we will contact the people listed below. Please list people in the order you wish them to be contacted. They must be able to pick up your camper within 30-40 minutes of contact.

Please complete Emergency Contact information below:*

	First and Last Name	Phone Number	Relationship to Camper
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3

I, signed below, authorize any of the above listed emergency contacts to make medical decisions on the behalf of my camper. *

Clear

Camper Medical Information
Does your camper have any life-threatening conditions or allergies?*

Yes. Described belowNo
If you answered yes to the above question please describe in detail any conditions or allergies:
Does your camper take any daily medication?*

Yes. Described belowNo
If you answered yes to the above question please describe in detail medication, dose and relevant emergency information
Please note that we are prohibited by law to administer any medication while at camp except in the case of a life-threatening emergency (ie epi-pen). You are responsible for supplying any emergency medications your child requires with instructions.
Health Insurance Provider:*
Policy Number:*

Summer Camp Session Selection and Release

Please select the sessions and schedules for your camper. Please be sure to read and sign the release information.

Session 1

Session 2

Session 3

June 26-July 7

(7/3+7/4 off)

July 10-July 21

July 24-August 4

Half Day	Full Day
8:30-12:30	8:30-3:30

*MP&MS Summer Camp is for children 2 years old (by June 1) to entering 2nd grade.

Questions? Please contact us at summercamp@mpms.org.

****Session 2 & 3 are FULL for campers between ages 2-3 years.****

Session Selections

Please select sessions for your camper and half/full day. Early Bird pricing (10% discount) will be available until 3/31/2023. If registering for the full summer please only select that option.

Full SummerJune 26-August 4 (7/3+7/4 off)

$2,500.00

Session 1June 26-July 7 (7/3+7/4 off)

$745.00 Half Day or Full Day?

Session 2July 10-July 21

$880.00 Half Day or Full Day?

Session 3July 24-Aug 4

$880.00 Half Day or Full Day?

Camp T-shirt!Summer 2023 Camp T-shirt is included in your registration fees! Please select a size.

$ Free Size

KIDS NIGHT OUT! July 14Movie Night!

$75.00

KIDS NIGHT OUT! July 28Movie Night!

$75.00

Enter coupon

Total

$0.00

Credit Card

Permission & General Release:
Please read and sign below.

I hereby agree that the child(ren) named above have my permission to attend all activities that are a part of the Marin Primary & Middle School summer camp program ("the Camp"), and I hereby agree not to hold Marin Primary & Middle School responsible for accidents or injuries to my child(ren) except to the extent that such accident or injury is directly related to Marin Primary & Middle School"s gross negligence.

*Sunscreen Permission: I hereby give permission for the Camp staff to apply or provide sunscreen to my child(ren).

*Medical Insurance: I understand and agree that it is my responsibility to provide accident and health coverage for the child(ren) named above while they are attending the Camp.

*Authorization of Use of Photographs/Videos: use of any pictures, texts, and or videos, of/by me or my child(ren) may be used for Camp training, advertising, and marketing without any compensation to me or my child(ren).

*Risk of Injury: I acknowledge that the Camp's activities may contain risks that may result in injury or death to me and/or my child.

*Understand all Policies: I have asked any questions I have about the Camp's policies and operations. All questions about policies and operations have been answered to my satisfaction.

*Enrollment Confirmation: I understand this registration does not guarantee a spot at camp. After registration is received, MPMS will send me a confirmation email along with more information about enrollment. In the event that camp is full, I understand my camper may be placed on a waitlist.

Refund Policy:

I understand and agree that to receive a full refund for camp tuition, I must withdraw from camp by 4/28/23. Thereafter, a 50% refund will be issued until 5/12/23. No refunds will be issued after 5/12/23. If camp closes due to public health regulations, a pro-rated refund will be issued.

I hereby agree to all the terms and conditions set forth above and additionally consent to my child(ren) participating in all camp activities.
Signature*

Clear
Questions? Please contact us at summercamp@mpms.org.
Should be Empty:

Registration Form

Aftercare!

Kids Night Out!

Secondary Parent/Guardian Information

Other Contacts and Medical Information

Summer Camp Session Selection and Release

Credit Card