Lyceum Summer Camp Registration
Spots are Still Available!
For Grades: 1st - 8th grade // Dates: June 5- August 4, 2023
Thank you for your interest in the Lyceum Village Summer Camp! All Day/Full Week = $550/week and Half Day/Full Week = $300/week Please fill out the form below in its entirety. If you have any questions or concerns, please contact akiko@lyceumvillage.org.
Camper 1 Information
Camper 1 Name
*
First Name
Last Name
*
Age
Grade Entering 2023
Please select which weeks and times Camper 1 will be attending summer camp.
AM
Extended Care
(8-9 AM) $12/day
FULL
DAY
(9AM-4:30PM)
AM Only
(9AM- 12:30PM)
PM Only
(1PM- 4:30PM)
PM
Extended Care
(4:30-5:30) $12/day
Week 1 (June 5- 9)
Week 2 (June 12- 16)
Week 3 (June 19- 23)
Week 4 (June 26- 30)
*Week 5 (July 3, 5, 6, 7)
WAITLIST for Week 6 (July 10- 14)
Week 7 (July 17- 21)
Week 8 (July 24- 28)
Week 9 (July 31- Aug 4)
AM Options: Default for AM Camp is Tupperberry Art and Theme Class. If your child prefers one of the options below, please select them and specify which weeks in the box below. Graphic Design (grades 3 and up) and Digital Art (grades 2 and up).No additional fee for AM options. You can read more about these options on our website: https://www.lyceumvillage.org/camps
Basketball Skills Training (8:30-12:00) Full AM or Half AM options
Pokemon Trading Card Clinic (9:15-10:45) and Theme Class (11-12:30)
Graphic Design Clinic (9:15-10:45) (Weeks 1, 3, 7 and 9) and Theme Class (11-12:30)
Digital Art Clinic (9:15-10:45) (Weeks 2, 4, 6 and 8) and Theme Class (11-12:30)
Tupperberry Art (9:15-10:45) and Theme Class (11-12:30)
Please specify which weeks you would like to participate in the AM Options.
Add-Ons: These add-ons have an additional cost and are in the PM only. Please select which of the following you are interested in for Camper 1. Spots are limited and not guaranteed. You can read more about the costs and details of these add-ons on our camp flier on our website: https://www.lyceumvillage.org/camps.
Private Music Instruction (Piano, Violin, Viola & Cello)
Inspired Writers' Workshop (3rd- 8th grade) 6/19-6/30
Startup for Young Entrepreneurs (3rd- 8th grade) July 10th-August 4th
Intensive Summer Chinese with Karis Academy 2:30-5:00
Private Tutoring (Math/Language Arts for 2nd- 8th grade)
PSAT/NMSQT
Would you like to register more campers?
Yes
No
Back
Next
Camper 2 Information
Camper 2 Name
*
First Name
Last Name
*
Age
Grade Entering 2023
Please select which weeks and times Camper 2 will be attending summer camp.
AM
Extended Care
(8-9 AM)
ALL
DAY
(9AM-4:30PM)
AM Only
(9AM- 12:30PM)
PM Only
(1PM- 4:30PM)
PM
Extended Care
(4:30-5:30)
Week 1 (June 5- 9)
Week 2 (June 12- 16)
Week 3 (June 19- 23)
Week 4 (June 26- 30)
*Week 5 (July 3, 5, 6, 7)
WAITLIST for Week 6 (July 10- 14)
Week 7 (July 17- 21)
Week 8 (July 24- 28)
Week 9 (July 31- Aug 4)
AM Options: Default for AM Camp is Tupperberry Art and Theme Class. If your child prefers one of the options below, please select them and specify which weeks in the box below. Graphic Design (grades 3 and up) and Digital Art (grades 2 and up).No additional fee for AM options. You can read more about these options on our website: https://www.lyceumvillage.org/camps
Basketball Skills Training (8:30-12:00) Full AM or Half AM options
Pokemon Trading Card Clinic (9:15-10:45) and Theme Class (11-12:30)
Graphic Design Clinic (9:15-10:45) (Weeks 1, 3, 7 and 9) and Theme Class (11-12:30)
Digital Art Clinic (9:15-10:45) (Weeks 2, 4, 6 and 8) and Theme Class (11-12:30)
Tupperberry Art (9:15-10:45) and Theme Class (11-12:30)
Please specify which weeks you would like to participate in the AM Options.
Add-Ons: These add-ons have an additional cost and are in the PM only. Please select which of the following you are interested in for Camper 2. Spots are limited and not guaranteed. You can read more about the costs and details of these add-ons on our camp flier on our website: https://www.lyceumvillage.org/camps
Private Music Instruction (Piano, Violin, Viola & Cello)
Inspired Writers' Workshop (3rd- 8th grade) Session 1: 6/5-6/16; Session 2: 6/19-6/30
Startup for Young Entrepreneurs (3rd- 8th grade) July 10th-August 4th
Intensive Summer Chinese with Karis Academy (2:30-5:00)
Private Tutoring (Math/Language Arts for 2nd- 8th grade)
PSAT/NMSQT
Would you like to register more campers?
Yes
No
Back
Next
Camper 3 Information
Camper 3 Name
*
First Name
Last Name
*
Age
Grade Entering 2023
Please select which weeks and times Camper 3 will be attending summer camp.
AM
Extended Care
(8-9 AM)
ALL
DAY
(9AM-4:30PM)
AM Only
(9AM- 12:30PM)
PM Only
(1PM- 4:30PM)
PM
Extended Care
(4:30-5:30)
Week 1 (June 5- 9)
Week 2 (June 12- 16)
Week 3 (June 19- 23)
Week 4 (June 26- 30)
*Week 5 (July 3, 5, 6, 7)
WAITLIST for Week 6 (July 10- 14)
Week 7 (July 17- 21)
Week 8 (July 24- 28)
Week 9 (July 31- Aug 4)
AM Options: Default for AM Camp is Tupperberry Art and Theme Class. If your child prefers one of the options below, please select them and specify which weeks in the box below. Graphic Design (grades 3 and up) and Digital Art (grades 2 and up). No additional fee for AM options. You can read more about these options on our website: https://www.lyceumvillage.org/camps
Basketball Skills Training (8:30-12:00) Full AM or Half Day options
Pokemon Trading Card Clinic (9:15-10:45) and Theme Class (11-12:30)
Graphic Design Clinic (9:15-10:45) (Weeks 1, 3, 7 and 9) and Theme Class (11-12:30)
Digital Art Clinic (9:15-10:45) (Weeks 2, 4, 6 and 8) and Theme Class (11-12:30)
Tupperberry Art (9:15-10:45) and Theme Class (11-12:30)
Please specify which weeks you would like to participate in the AM Options.
Add-Ons: These add-ons have an additional cost and are in the PM only. Please select which of the following you are interested in for Camper 3. Spots are limited and not guaranteed. You can read more about the costs and details of these add-ons on our camp flier on our website: https://www.lyceumvillage.org/camps
Private Music Instruction (Piano, Violin, Viola & Cello)
Inspired Writers' Workshop (3rd- 8th grade) Session 1: 6/5-6/16; Session 2: 6/19-6/30
Startup for Young Entrepreneurs (3rd- 8th grade) July 10th-August 4th
Intensive Summer Chinese with Karis Academy (2:30-5:00)
Private Tutoring (Math/Language Arts for 2nd- 8th grade)
PSAT/NMSQT
Back
Next
Parent Information
Parent 1 Name
*
First Name
Last Name
Cell Number
*
E-mail
*
example@example.com
Parent 2 Name
First Name
Last Name
Cell Number
E-mail
example@example.com
Payment Method
Choose payment method
Zelle
Check
Emergency Contact Information
Emergency Contact's Name
First Name
Last Name
Relationship
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
Alt. Phone Number
Does the camper(s) have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper(s) prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement
I hereby give my approval for my child's/children's participation in any and all activities prepared by Lyceum during the selected camp. In exchange for the acceptance of said child’s/children's candidacy by Lyceum, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Lyceum and all its respective officers, agents, and representatives from any and all liability for injuries to said child/children arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child/children, I hereby waive all claims against Lyceum- including all coaches, teachers, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the camp. There is a risk of being injured that is inherent in all activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
As Parent and/or Guardian of the named camper(s), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child/children, 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(s). 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 Lyceum. and its affiliates including Directors, Teachers, Coaches, and Team 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 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/children, in my absence.
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.
Signature
*
Date
-
Month
-
Day
Year
Date
Type a question
Submit
Should be Empty: