The Magnolia School Summer Camp

The Magnolia School Summer Camp Registration

Register Now!
Student Information

Student 1
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade

Rising PreK3Rising PreK4Rising Kinder-BridgeRising KinderRising 1stRising 2ndRising 3rdRising 4thRising 5thRising 6thRising 7thRising 8th
Gender*

MaleFemale
Camp Enrollment Weeks:*

Week 1: June 2nd - 6thWeek 2: June 9th - 13thWeek 3: June 16th - 20thWeek 4: June 23rd - 27thWeek 5: July 7th - 11thWeek 6: July 14th - 18thWeek 7: July 21st - 25th
AM, PM, or Full-Day Camp Sessions*
Please select if you would like your student to be enrolled for AM, PM or Full-Day Camp Sessions
What Academic Subjects are you interested in your student participating in:

ELAMathBoth
Enrolling in Performance Camp(s) - this is an additional $100 per Performance Camp.

YesNo
Performance Camp Options

June 16-20 AM Theater Camp (3 years to 5 years old)June 16-27 PM Acting for Film/Movie Camp (6 years to 13 years old)June 23-27 AM HipHop Tumbling (3 years to 5 years old)July 7-11 PM Mixed Media Art (6 years to 13 years old)July 14-18 AM HipHop Tumbling (3 years to 5 years old)July 14-25 PM Acting for Film/Movie Camp (6 years to 13 years old)July 21-25 AM Theater Camp (3 years to 5 years old)
Aftercare enrollment from 3:30-5:30 M-F at a cost of $100 per week or $30 per day.

YesNo
If you have more than one student attending The Magnolia School Summer Camp, please fill out another form. Additionally, please note a one-time $50 assessment fee will be collected for kids not currently enrolled with The Magnolia School. This brief assessment happens before the first day of camp and allows kids to join homogeneous groups during camp.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Medical Release
PERMISSION TO TREAT: I hereby authorize The Magnolia School permission to treat my child in case of an emergency until I can be reached.*

YesNo
I give permission for The Magnolia School to administer the following prescription medication to my student.
Medication Name, Dosage, and When to Administer
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.
The full registration fee is due at the time of registration. We will send you a follow-up link to submit payment within 48 hours.
Date*

MonthDayYear
Date
Signature*

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The Magnolia School Summer Camp Registration

Student Information

Medical Release