Camp Elevate @ Sky Zone Waldorf Registration Form

Camp Elevate @ Sky Zone Waldorf Summer Camp Registration (June 17th-August 16th)

***Please complete one form per camper***
Facilitated by Sky Zone Waldorf, Camp Elevate is an innovative summer camp for children ages 6-12. At Camp Elevate, we combine STEM, social and emotional learning, and literacy to foster a fun, academically enriching experience. The mission of Camp Elevate at Sky Zone is to cultivate social and emotional development, literacy enrichment, and STEM in a fun and engaging way!
Camper Name

Please complete one registration form per camper.
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Camper's Information
Address*
City*
State*
Zip*
Home Phone*

Area CodePhone Number
Emergency Contact Name (if parent or guardian is not available)*
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Birth Date*

MonthDayYear
Camper's Current Grade*
What are some of your child’s hobbies and interests?
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Email*
example@example.com
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Email
example@example.com
Please list the full names of all persons authorized to pick up your child(den). Please only list the names of those who are authorized to pick up your child, as they can not be released to anyone else.
Please list the names of any siblings who are attending camp.
Camper Schedule

Regular Registration Full Day (8:00 am-4:30 pm)/Full Week Enrollment. This registration is for one full week of camp (Monday-Friday from 8:00am-4:30pm for ONE child).
Which week's are you registering for?

June 17th- June 21stJune 24th- June 28thJuly 1st- July 5th (no camp on 7/4)July 8th- July 12thJuly 15th- July 19thJuly 22th- July 26thJuly 29th- August 2ndAugust 5th- August 9thAugust 12th- August 16th
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident, injury, or emergency. Please provide the following information so that we may have adequate medical information for your child.
Health Insurance Company
ID/Policy Number
Group Number
Name of Primary Care Physician
Phone Number
Is camper free from infectious disease or conditions?*

YesNo
Date of last tetanus shot*
Any activity the camper should be restricted from?*
Please list all medical conditions and food allergies that we should be aware of. *
Please list any social and/or emotional needs that we should be aware of to best serve your child. *
Any dietary needs that we should know about?*
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.*
I understand that Camp Elevate staff is not authorized to administer any medication to my child. I understand that all prescription medication must be self-administered.

Clear
My child has consent to participate in all Camp Elevate activities.

Clear
In the event of an emergency situation requiring medical treatment of the camper during his/ her attendance at the camp, I/we, the undersigned parent(s)/guardian(s) of the camper, give the Camp Elevate staff my/our consent and authorization for all medical treatment that is deemed necessary by qualified medical personnel for the proper care and treatment of the camper, including but not limited to administration of first-aid and use of an ambulance.

Clear
Payment Information

$220 per week registration fee

CAMP Elevate Registration Fee (please pay the total amount for the weeks you are registering for. Campers must bring their own lunch. However, snacks will be provided throughout the day)*

Camp Elevate Weekly Registration FeeThe weekly fee of $220 if for one (1) camper (Monday-Friday, except the week of 4th of July which is a short week) from 8am-4:30pm. All campers must bring a bag lunch each day. Lunch should be peanut free. Camp Elevate will provide two (2) snacks per day.

$220.00

Selected Weeks That You Are Registering For	Quantity
June 17th- June 21st
June 24th- June 28th
July 1st- July 5th (no camp on 7/4)
July 8th- July 12th (no camp on 7/4)
July 15th- July 19th
July 22nd- July 26th
July 29th- August 2nd
August 5th- August 9th
August 12th- August 16th

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

By hitting submit and signing below, you agree that you are the parent or legal guardian of the above named camper. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend Camp Elevate and participate in all activites. I understand that I must complete a waiver for Sky Zone Waldorf prior to my child's participation in Camp Elevate.
Signature*

Clear
Electronic signature, please initial*
Should be Empty:

Camp Elevate @ Sky Zone Waldorf Summer Camp Registration (June 17th-August 16th)

Camper Name

Camper's Information

Parent or Legal Guardian Information

Camper Schedule

Health Information

Payment Information

Payment Methods