Summer BLAST! Camp Registration

Summer BLAST! Camp Registration

Please fill out one form per camper
Select Your Camp Product(s)
prevnext( X )
MEGA BLAST! Camp Week 1 June 8-12
$650.00



FULL BLAST! Camp Week 2 June 15-19 2026
$650.00



PAYMENT OPTIONS FOR BLAST! CAMPPayments for both Full and Mega BLAST! are made to Camp Director Andrew Slayton. You can Zelle or Apple Pay (415) 350-2379. For other payment options please email aslayton@pinewood.edu. Payment MUST be made prior to check out or your registration will not be complete.
$ Free



Aftercare MEGA BLAST! WEEK 1 June 8-12 2026
$200.00



Aftercare FULL BLAST! WEEK 2 June 15-19 2026
$200.00



PAYMENT OPTIONS FOR AFTERCAREPayments for Aftercare are made directly to Aftercare Director Caitlin Ciardella. You can Zelle (650) 255-5899 or use Caitlin.ciardella@gmail.com. For other payment options please email cciardella@pinewood.edu. Payment MUST be made prior to check out or your registration will not be complete.
$ Free



Total

$0.00
Your Camper
Camper Full Name*

First NameLast Name
Grade of Camper*
(current grade for Winter and Spring BLAST!, Fall 2026 grade for Summer BLAST!)
School of Camper*
Life Threatening Allergies or other Medical Concerns*
If YES life threating allergies, does camper require Epi-Pen?
If you care to share a little about your child, please list your child's Top 3 favorite activities. Please list one way your child likes to recover when frustrated or sad. Please tell us anything else you think we should know about your child prior to camp.
Parent / Guardian
Mother/Parent #1*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
Email *
example@example.com
Father/Parent #2*

First NameLast Name
Cell Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Emergency Contact*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
BLAST! Camp Waiver and Release of Liability Form
BLAST! Camp Waiver and Release of Liability Form

I hereby give my permission for my child(ren) to participate in the BLAST! Camp Program.

Participation in any program which involves physical activity exposes the camper to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the camper from all conceivable dangers.

I hereby affirm that my child(ren) has/have no conditions that would make it unsafe for him/her/them to participate in the camps program(s) selected.

I understand that BLAST! Camp may exclude my child(ren) from camp in the event that I or my child(ren) fail to abide by the health and safety protocols, disrupt, impede or interfere with the operations of camp, or threaten the health, safety or welfare of other participants or camp staff, and that no refund of any fees will be made in such circumstances.

Medical Consent:

I understand that BLAST! Camp will make every effort to contact me in the case of an emergency. By signing this document, I agree to allow BLAST! Camp and its staff to administer any medications needed and to provide and arrange for and consent to any necessary medical treatment for my child(ren) while at camp, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.

Photography Release:

*Please select in question below if you accept or decline photography release for your child(ren)

In consideration of my child(ren)’s participation at BLAST! Camp, and without any further consideration from BLAST! Camp, I hereby grant permission to the BLAST! Camp staff and affiliates to utilize my child(ren)’s appearance, performance, or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication. BLAST! Camp may use my child(ren)’s, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph.

By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my child(ren), I hereby voluntarily release and discharge BLAST! Camp, its trustees, officers, employees, agents, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my child(ren)’s participation in camp. I agree, for myself and my child(ren), not to make any type of legal or equitable claim on BLAST! Camp, or any of its trustees, officers, employees, agents, insurers or contractors with respect to any injury I or my child(ren) may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with BLAST! Camp, including other campers. I further agree that if any such claim is made, I will indemnify and defend BLAST! Camp with respect to any such claim, injury or damage.
Do you accept or decline photography release for your child*

I acceptI decline
Sign below acknowledging you've read and agreed to the BLAST! Camp Waiver and Release of Liability Form *

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Summer BLAST! Camp Registration

Your Camper

Parent / Guardian

BLAST! Camp Waiver and Release of Liability Form