Woodward Summer Program Registration Form

Woodward Summer Program Registration Form
The Woodward Summer Program runs daily from 9:00 AM to 3:00 PM. Join us for four weeks of engaging courses and activities on the following dates:
- Week 1: July 6 – 10
- Week 2: July 13 – 17
- Week 3: July 20 – 24
- Week 4: July 27 – 31
Course Selection & Registration
You can view our full course catalog [here].

Once you submit this registration form, you will receive a confirmation email including an invoice for your total balance and insturctions on how to make a payment. After registration, we will contact you to officially confirm which specific courses your student will participate in during their selected weeks.

Tuition & Add-Ons
- Weekly Tuition: $500 - Includes weekly field trip and Friday lunch.
- Lunch Program: $40/week - Optional lunch ordering for Monday - Thursday
- Early Drop-Off: $100/week - Available starting at 8:00 AM
Contact Us

If you have any questions regarding the program or the registration process, please contact our Summer Program Director:

Cami Furlong: cfurlong@thewoodwardschool.org
Student Information
Choose your student's Summer Session(s)*

Session 1 - July 6 to 10Session 2 - July 13 to 17Session 3 - July 20 to 24Session 4 - July 27 to 31
Full Name*

First NameLast Name
Preferred Name
Preferred Pronouns*
Date of Birth*

MonthDayYear
Date
Gender*
What grade is your student entering this Fall?*

4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade
Is your student a member of any of the following?*

Current Student at The Woodward SchoolMember of QCareCurrent Girl ScoutNone of the Above
Lunch Information:

This year, lunch is included on the field trip day of the week, which is usually Friday. For the other four days of the week students may bring a lunch or order lunch with us for $40/week. The cost for ordering lunch will be added to your invoice at time of registration.
Please select which lunch option your student will take part in:*

My student will bring lunchMy student will order lunch for $40/week
Would you like to add Early Drop Off for $100/week?*

YesNo
Would you like to sign up a second student?*

YesNo
Choose your 2nd student's Summer Session(s)*

Session 1 - July 6 to 10Session 2 - July 13 to 17Session 3 - July 20 to 24Session 4 - July 27 to 31
2nd Student Full Name*

First NameLast Name
2nd Student Preferred Name
2nd Student Preferred Pronouns*
2nd Student Date of Birth*

MonthDayYear
Date
2nd Student Gender*
What grade is your 2nd student entering this Fall?*

4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade
Is your 2nd student a member of any of the following?*

Current Student at The Woodward SchoolMember of QCareCurrent Girl ScoutNone of the Above
Lunch Information:

This year, lunch is included on the field trip day of the week, which is usually Friday. For the other four days of the week students may bring a lunch or order lunch with us for $40/week. The cost for ordering lunch will be added to your invoice at time of registration.
Please select which lunch option your 2nd student will take part in:*

My student will bring lunchMy student will order lunch for $40/week
Would you like to add Early Drop Off for $100/week for your 2nd student?*

YesNo
Parent/Guardian Information
Full Name*

First NameLast Name
Relationship to Student*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts

In case of emergency, we will first attempt to reach the listed Parent/Guardian first. We will then proceed to the next listed Emergency Contacts. Please make sure you have at least one listed.
1st Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student*
2nd Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student
Student Health Information

In addition to completing the following section, a current physical exam and up-to-date immunization record must be submitted for each camper. Please email these documents to Kristin Russell in the Business Office at businessoffice@thewoodwardschool.org. Students may not participate until all required documentation is received.
Physician's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Student's Physician*
Policy Number*
Health Insurance Provider*
Name of Policy Holder*
Policy Holder Date of Birth*

MonthDayYear
Date
Does the student have any medical conditions?*

YesNo
If yes, please specify the medical conditions:
If yes, please specify the allergies:
Does the student have any allergies requiring an EpiPen?*

YesNo
Does the student have asthma requiring an inhaler?*

YesNo
Does the student take any medications (even if administered at home)?*

YesNo
If yes, please list the medications (even if not administered during the summer program):
Please provide any additional health or safety information camp staff should be aware of:
Authorizations
Medical Release:

There may be a rare instance (e.g. medical or surgical emergency ) in which consent by the parent or guardian is legally required, but the proper person cannot be reached. In this event, and in order to avoid delay which might jeopardize the life or recovery of a student, we request the following authorization from the parent or guardian, with the understanding that every effort will be made to contact them in an emergency.
I hereby authorize the health care providers and agents by Woodward Summer Institute staff to secure necessary treatment(s) including hospitalization, anesthesia, and emergency surgery for this student.*

By selecting this button, I agree to the above statement.
Handbook Acknowledgement:

Please read through the handbook.
I acknowledge receipt of the Family Handbook and will adhere to the policies.*

By selecting this button, I agree to the above statement.
Media Release: I consent to have photographs and/or videos of my daughter for use by the school. I understand that any photo/video would be used solely to publicize school programs or to illustrate educational activities. If a student's name is used, only their first name and last initial will be published.*

Yes, I give my consentNo, I do not give my consent
Authorization for Field Trips: I understand that my daughter may leave The Woodward School building during a program day with a Summer Program staff person on an outing or field trip that is a Woodward Summer Program approved and educationally sound activity.*

Yes, I authorize my child to participateNo, I do not authorize my child to participate
I hereby authorize the health care providers and agents by Woodward Summer Institute staff to secure necessary treatment(s) including hospitalization, anesthesia, and emergency surgery for this student.*

By selecting this button, I agree to the above statement.
Should be Empty:

Woodward Summer Program Registration Form

Student Information

Parent/Guardian Information

Emergency Contacts

Student Health Information

Authorizations