Camp Kooka-Racha 2024 Registration

Camp Kooka-Racha 2024 Registration

Welcome to Camp Kooka-Racha! Please read the following instructions before you fill out the registration form. Thank you!
1. Complete ONE form for ALL campers and ALL camp sessions.

2. Each session is $365 per camper.

3. A non-refundable 50% deposit is due at the time of registration.

4. An invoice for the remaining amount will be sent to the email you provide in the invoice section of this form. All sessions must be paid in full by May, 15th 2024.

5. You will receive a confirmation email once you submit this form. At this point, if you have any special instructions, amendments, or additional information that would help your camper have the most successful week, please send an email to admin@westlawnschool.org with the subject line "CKR 2024 [Your Camper's Name] Additional Information".

We can't wait to see you this summer!

Camper Information
Camper #1 Name*

First NameLast Name
Date of Birth*

MonthDayYear
T-Shirt Size*
I provide consent for my child {camper1} to appear in media (e.g., pictures, and videos) which will be shared with only other families who partake in Camp Kooka Racha.
Internal Media Consent*

Yes, I give consent.No, I do not give consent.
I provide consent for my child {camper1} to appear in media (e.g., pictures, videos) which will be shared on social media platforms (e.g. Website, Facebook, Instagram, Marketing Materials).
External Media Consent*

Yes, I give consent.No, I do not give consent.
Camper's Doctor

Doctors NamePractice
Allergies, Medical Conditions, or Other Special Instructions:
If left blank, this field will automatically fill in "none".
Do You Have a Second Camper to Register

YesNo

Camper #2 Name

First NameLast Name
Date of Birth

MonthDayYear
T-Shirt Size
I provide consent for my child ({camper2}) to appear in media (e.g., pictures, and videos) which will be shared with only other families who partake in Camp Kooka Racha.
Internal Media Consent*

Yes, I give consent.No, I do not give consent.
I provide consent for my child {camper2} to appear in media (e.g., pictures, videos) which will be shared on social media platforms (e.g. Website, Facebook, Instagram, Marketing Materials).
External Media Consent*

Yes, I give consent.No, I do not give consent.
Camper's Doctor

Doctors NamePractice
Allergies, Medical Conditions, or Other Special Instructions:
If left blank, this field will automatically fill in "none".
Do You Have a Third Camper to Register

YesNo

Camper #3 Name

First NameLast Name
Date of Birth

MonthDayYear
T-Shirt Size
I provide consent for my child {camper3} to appear in media (e.g., pictures, and videos) which will be shared with only other families who partake in Camp Kooka Racha.
Internal Media Consent*

Yes, I give consent.No, I do not give consent.
I provide consent for my child {camper3} to appear in media (e.g., pictures, videos) which will be shared on social media platforms (e.g. Website, Facebook, Instagram, Marketing Materials).
External Media Consent*

Yes, I give consent.No, I do not give consent.
Camper's Doctor

Doctors NamePractice
Allergies, Medical Conditions, or Other Special Instructions:
If left blank, this field will automatically fill in "none".

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Relationship to Campers
ex: Parent, Grandparent, Aunt, Uncle, etc.
Address*

Street Address

Street Address Line 2

CityState

Postal Code
Phone Number*
E-mail*
Emergency Contact (Other Than The Parent Above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Relationship to Your Camper
ex: Grandparent, Neighbor, Family Friend

My Products

50% Deposit

$182.50 Number of Sessions

Total

$0.00

Session Registration