Wonder Boxed Summer Camp Registration Form

Student Name

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Grade (What grade will your child have completed by June 1st?)

Gender

Address

Street Address

Apt/Unit #

CityState / Province

Postal / Zip Code

Parent/Guardian Information (Primary)

Name

First NameLast Name

Cell Number

Format: (000) 000-0000.

E-mail

Confirmation Emailexample@example.com

Relationship

Parent/Guardian Information (Secondary)

Name

First NameLast Name

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Relationship

Emergency Contact (someone other than a parent/guardian)

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Does this student have any allergies, chronic illness, or medical conditions? If yes, please describe.

Does your child have any learning needs or accommodations we should be aware of? If yes, please share below.

Is this student prescribed an inhaler? If yes, please explain any instructions.

Does this student have any dietary restrictions? If yes, please list them below.

Camper T-shirt Size

Select the weeks your child will attend camp (check all that apply):

Will your child need:

Camper Photo & Media Release: I grant permission for my child to be photographed, videotaped, and/or recorded while participating in camp activities. I understand that these images and recordings may be used by Wonder Boxed STEM & Literacy Innovation Camp for marketing, promotional, and educational purposes.This includes, but is not limited to, use on social media platforms, websites, digital and print marketing materials, newsletters, advertisements, and end-of-summer highlight recaps or program showcases.I understand that no compensation will be provided for the use of these images or recordings, and that all media will be used in a respectful and appropriate manner to represent the camp experience.

Is there anything else you would like us to know about your child to ensure they have the best possible experience?

Informed Consent and Acknowledgement

I hereby grant permission for my child to participate in all activities associated with Wonder Boxed STEM Education Inc., including the Wonder Boxed STEM & Literacy Innovation Camp. I understand that camp activities include, but are not limited to, weekly field trips, physical education (PE), recess, hands-on STEM and literacy activities, and both indoor and outdoor programming.

I acknowledge that participation in these activities may involve certain inherent risks, including travel to and from field trip locations, physical activity, and group participation. In consideration of my child’s participation, I voluntarily assume all risks associated with these activities.

I hereby release, waive, discharge, and hold harmless Wonder Boxed STEM Education Inc., Wonder Boxed STEM & Literacy Innovation Camp, Wonder Boxed LLC, and all of their officers, employees, agents, affiliates, volunteers, and representatives from any and all claims, liabilities, damages, or causes of action that may arise out of or relate to my child’s participation in camp activities, including transportation to and from activities.

In the event of an emergency or injury, I authorize camp staff to seek appropriate medical attention for my child if I cannot be reached, and I agree to be responsible for any medical expenses incurred.

By signing below, I acknowledge that I have read, understand, and agree to the terms outlined above.

Medical Release and Authorization

As the parent and/or legal guardian of the registered child, I hereby authorize Wonder Boxed STEM Education Inc., including the Wonder Boxed STEM & Literacy Innovation Camp, to obtain emergency medical care for my child in the event of an illness or injury requiring immediate attention.

I understand that camp activities include, but are not limited to, weekly field trips, physical education (PE), recess, hands-on STEM and literacy activities, and both indoor and outdoor experiences. I acknowledge that, while reasonable precautions are taken, emergencies may occur.

In the event of a medical emergency, I authorize qualified and licensed medical professionals to evaluate, diagnose, and provide necessary medical treatment for my child, including but not limited to first aid, emergency care, x-rays, routine medical procedures, and, if deemed necessary, minor surgical treatment.

I understand that every reasonable effort will be made to contact me or my designated emergency contact prior to administering treatment. However, in the event that I cannot be reached in a timely manner, I grant permission for treatment to proceed as deemed necessary by medical personnel to prevent further injury, illness, or harm.

I also authorize Wonder Boxed STEM Education Inc., its directors, staff, agents, and representatives to provide or arrange for emergency care, including transportation to a medical facility, if needed, prior to my arrival.

This authorization is valid for the full duration of my child’s participation in the Wonder Boxed STEM & Literacy Innovation Camp.

By signing below, I acknowledge that this authorization is given voluntarily for the purpose of protecting the health, safety, and well-being of my child.

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.

Date

Signature

Complete Payment to Confirm Your Registration

Registration Fee

NON-REFUNDABLE

$50.00

Official Camp T-Shirt

Required for the First Day of Camp and all Field Trip Fridays to ensure safety, unity, and easy identification of campers.

$13.00 Quantity

Tuition Week of Camp (Optional)

Select all the weeks you’d like to secure and pay for today.

$150.00 Quantity

Drop In Day Pass

Please select the number of days your child will be joining us

$50.00 Quantity

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Summer Camp Registration

Student Information

Complete Payment to Confirm Your Registration*

Payment Methods

Complete Payment to Confirm Your Registration