Camp Summer Quest & Rooted Summer Childcare

Camp Summer Quest & Rooted Summer Childcare

Registration Form
Summer 2026
Time: 9:30 AM - 3:30 PM
Location: The Rooted Learning Collective
6301 Wallingford Drive, Fort Worth, TX 76133

Notes:

Camp - Grades 1-6

Dates and Options Below
Cost for Camp Summer Quest

$180 Summer Camp Sessions are weekly (Tuesday, Wednesday, and Thursday only) 9:30-3:30 and includes expense for one field trip/outing, *10% discount toward siblings
Cost for Rooted Childcare

$50/day (Available on Mondays and Fridays only and for campers only) 9:30-3:30, must submit request, confirm availability, and receive confirmation for approval, spots are limited. This is designed and made available to campers in order to accommodate working parents and those who desire a M-F experience. Requests for this add-on should be made in writing below the Camp Session Selection Section.
Cost for Before and After Care

Additional $5/morning, not to begin before 8:30 am and/or an additional $5/afternoon, not to exceed 4:30 pm. Must submit request, confirm availability, and receive confirmation for approval, spots are limited. Requests for this add-on should be made in writing below the Camp Session Selection Section.
Select your CAMP Sessions (T,W,TH) Below

You may choose multiple weeks.
Session 1 (June 2-June 4)
Session 2 (June 9-June 11)
Session 3 (June 16-June 18)
Session 4 (June 23-June 25)
Session 5 (July 7-July 9)
Session 6 (July 14 -July 16)
Session 7 (July 21-July 23)
OTHER REQUESTS * see below
Make Requests for Before or After Care (Available M-F) AND Childcare (Available Mondays & Fridays only) HERE. *CLOSED week of June 29-July 3 in observance of July 4th* Specify Needs, Dates and Type of Request. Our director will contact you through email to confirm availability. State N/A if NOT APPLICABLE*
Camper/Child's Information

Please complete separate registration for each child.
Camper Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Gender*
School Name*
Grade/Level*
Has your child attended our camp in the past?*
Will your child attend camp with any siblings? If so, list their names here. If not, state N/A.*
How did you hear about Camp Summer Quest?
Medical Information
Please let us know if you have any allergies, existing illnesses or any medical conditions.*
Are you currently taking any medication? If yes, please provide the generic name and its purpose?*
We spend time outdoors and in the pool daily. Is your child a proficient swimmer? Please note, any child that is not proficient, is required to bring and wear a flotation device while in the pool. *

Parent/Guardian Details
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Debit/Credit CardChecks (mail to address listed below)
Note: We do not refund for missed visits. However, we do offer make up dates and issue credit for future dates. Should an emergency arise or if your child is unwell, please reschedule for better day.
Acknowledgment, Authorization, and Waiver
This camper has my authorization to engage in the activities of the Summer Quest Camp and/or Rooted Childcare at The Rooted Learning Collective, Inc. program.

I allow taking photography of this camper that can be used for The Rooted Learning Collective portfolio or advertising.

I authorized staff at The Rooted Learning Collective to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I allow staff at The Rooted Learning Collective to provide or administer the medication or supervise in self-administration with my written permission.

I release The Rooted Learning Collective, Inc. and any of its assistants, staff, and director for any responsibility in case of accident, illness, or injury during this camper's/child's enrollment.
Date Signed*

MonthDayYear
Date
Parent/Guardian Signature*

Powered by Jotform SignClear
CAMP SUMMER QUEST

ROOTED CHILDCARE

at The Rooted Learning Collective, Inc.

6301 Wallingford Drive - Fort Worth - TX - 76133
817-296-7483

info@therootedlearningcollective.com

www.therootedlearningcollectiv.com
Should be Empty:

Camp Summer Quest & Rooted Summer Childcare

Cost for Camp Summer Quest

Cost for Rooted Childcare

Cost for Before and After Care

Select your CAMP Sessions (T,W,TH) Below

Camper/Child's Information

Medical Information

Parent/Guardian Details

Emergency Contact Details

Acknowledgment, Authorization, and Waiver