Summer STEM Camp Registration 2025

2025 STEM Summer Camp

Space is limited.... Save your place today !!!
Early Bird Registration OPENS January 1st, 2025
Designed and lead by Certified and licensed professional in the field of pediatric Occupational Therapy with over 30 years experience, these camps provide a unique small groups setting with integrated therapeutic insight. Capped at 10 campers per camp. One form and payment per camper please.
Only 1 discount may be applied
Summer fun! A 20% discount will be applied to all registrations Through August

Only one discount can apply
Educator's 20% Discount: Home School educators- camp and groups (no expiration)

Name and county of your Home School . Principle's name **Information is requested to verify Home School and confirm eligibility for discount
Camper's Name*

First NameLast Name
Camp Location : OT4Kids, 440 Central Ave., Lexington, NC

Monday - Wednesday for 3 hours each day

Cost before discout $225 after discount $180 per child

*one Discount applied at check out*

Program Administrator: Carol Powell COTR/L

Coordinator: Patricia Miranda COTA/L TEXT: 336-250-9858
Child's age*
Are there challenges in the area self regulation, social skills, or other that may hinder your child's safety or participation in a small group setting with a 1:10 ration? please note below
Parent's Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Choose a 3 day camp*
List any medical concerns or diagnoses to help us know your child better. type none i there are no concerns *
Allergies to food or farm animals or type none? * .

** Your child must be pick up by you unless otherwise stated by you. My child can be pick up by (Type full name, relation to child, and contact number of additional person) * .
I hereby grant The Exceptional Me and OT4 Kids inc. staff the irrevocable right and permission to use photographs and/or video recordings of me and/ or my child on OT4 Kids and other websites, publications, social media platforms, in promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me. *
PAYMENT AGREEMENT: Once the camp fee in paid it holds your child' s place and cannot be refunded in whole or in part*
Signature*

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Personal Injury Waiver Form

This Personal Injury Waiver (the "Waiver") is made by the undersigned for the purpose of utilizing the facilities and premises managed by OT4KidsInc., (the "Company"), with the location at 440 Central Ave, NC 27292. and in the acknowledgment that in the utilization of the premises and facilities of the Company, occupies risk of personal injury that may arise or happen at any time.

In consideration of the Company allowing the undersigned to make use of the venue and its facilities and equipment for the relevant purpose by which the Company allows, the undersigned agrees to assume the foreseeable and unforeseeable risk of personal injuries related to the activity, and agrees to release, discharge, and hold harmless the Company, its owner(s) and employees free from any and all liabilities, claims, cause of action, damages, or losses, which may be incurred by the undersigned in using said premises and its equipment and/or facilities, and which may arise from any reason whatsoever, specifically including, but not limited to, any negligence on the part of the owners, its employees, or losses arising from theft or for any other reason whatsoever.

This Waiver shall be binding upon the parties, their respective heirs, representatives, successors, and assigns.

In case any part of this Waiver be construed as improper or invalid, such invalidity will affect only that part of this Waiver and the rest shall remain valid and enforceable.

Any alteration, modification, or amendment to this Waiver shall not be considered as valid unless otherwise written and signed by the undersigned herein.
Responsible Party's name blanks* . Date blank* .
Signature*

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Only one discount may be applied
Select appropriate choice to the left of the icon before payment*
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Early Bird and Home Educator's Discount January 1st-April 30th20% off: Choose camp date, age group, and time above
$180.00 Quantity

I would like to send a child to campSponsor a child to attend camp
$150.00 Quantity

Total

$0.00
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2025 STEM Summer Camp

Early Bird Registration OPENS January 1st, 2025

Only 1 discount may be applied

Summer fun! A 20% discount will be applied to all registrations Through August

Only one discount may be applied