DWS Summergarden Camp Enrollment

DWS Summergarden Camp Enrollment

This is a long form, so we suggest completing it using a computer. One application must be submitted for each child. Course enrollment occurs at the end of this form and, should you wish to enroll another child, you can select the link and information will be prefilled on the new form.
PAYMENT: Full payment is required with each application.

REFUNDS: You can cancel by May 15, 2024, and receive a full refund minus a $75 processing fee. After May 15th, 50% refunds will be given. Please note that no refunds will be issued once the week has begun. Cancellations must be requested in writing and sent to office@daviswaldorf.org.

WAITLIST: If a camp is SOLD OUT, you can add your child to the waitlist.
Child's Name*

First NameLast Name
Entering Grade*
Date of Birth*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Physician's Name*
Physician's Phone Number*
Please enter a valid phone number.
Please list any social, emotional, psychological, language and/or academic challenges
Please share any other important information so that we may best be prepared for your child

Medical Coverage*
Policy Number*
Medication currently being taken by child at home and/or at school (include time and dosage). Such medication needs to be provided to the office along with a doctor's prescription. Note n/a if not applicable.*
List all known allergies or dietary restrictions. Enter n/a if not applicable.*
Are there any factors a teacher should know about your child's health, or that a doctor should be aware of before treating your child (e.g., allergic reaction to penicillin, bee stings)? Enter n/a if not applicable.*
What should be done if your child has a complication due to his/her health condition or allergies? Enter n/a if not applicable.*

If my child is injured, ill or must leave school for any reason, and the parent or guardian listed below cannot be reached, the school is authorized to call and release your child to:
Name
Name
Phone
Phone
Relationship
Relationship
Name - Parent 1*
Name - Parent 2
Cell Phone Number - Parent 1*
Please enter a valid phone number.
Cell Phone Number - Parent 2
Please enter a valid phone number.
Work Phone Number - Parent 1
Please enter a valid phone number.
Work Phone Number - Parent 2
Please enter a valid phone number.
Home Phone Number
Primary Email Address*
example@example.com
Informed Consent and Acknowledgement

Parent(s)/Guardian(s) agree to release and hold harmless, the Davis Waldorf School ("School"), its employees, directors and agents, from all claims, damages or other liabilities for injuries to their child(ren), which are not the result of gross negligence by the School or its agents or employees, when participating in on- or off-campus school sponsored activities. The Parent(s)/Guardian(s) also agree to accept financial responsibility to reimburse the School for any damage or loss to the School, its property, or any “Third party” property damage their child caused, for which the School was required to correct, repair or replace. The School is not responsible for damage to or theft of personal property.

Parent(s)/Guardian(s) give permission for their child to participate in off-campus walks under teacher or school employee supervision. Parent(s)/Guardian(s) acknowledge that off-campus walks may include passing by, or stopping at, bodies of water in the surrounding neighborhoods.

In the event of an accident or other emergency, when the Parent(s)/Guardian(s) is( are) unavailable, the School may authorize a representative to make any arrangements considered necessary for the student to receive medical or hospital care, including necessary transportation. Under such circumstances, the Parent(s)/Guardian(s) further authorize any licensed physician or surgeon to undertake any care and treatment of the student considered necessary. The Parent(s)/Guardian(s) hereby agree to pay all costs incurred as a result of the foregoing.

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.
Please note: If you child has any medications that need to be taken during camp hours (or an allergy that requires an Epi Pen), additional paperwork is required - please email registrar@daviswaldorf.org
Date*

MonthDayYear
Date
Signature*

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DWS Summergarden Camp Enrollment

If my child is injured, ill or must leave school for any reason, and the parent or guardian listed below cannot be reached, the school is authorized to call and release your child to: