Summer Camp Registration

2019 PURE GENIUS SUMMER CAMP REGISTRATION

Inspiring the genius in your little Einstein!

Please select the camps for which you want to register:

July 29-Aug. 2 (9am-4pm): SPY CAMP @ Pure Genius $ 250.00

Extended Care (before/after camp) - SPY CAMP $ 30.00

Enter coupon

Total $ 0.00

Child's Name *

First Name Last Name
Grade (in the upcoming school year)
Mom, dad, or legal guardian: *

First Name Last Name
Phone Number *

Area Code Phone Number
Home Address: *
State *
Zip: *
E-mail *
Mom, dad, or other legal guardian:

First Name Last Name
Cell Phone Number:

Area Code Phone Number
Does your child have any health conditions or allergies that we should know about? If so, please explain:
Emergency Contact: *

First Name Last Name
Emergency Contact Telephone Number: *

Area Code Phone Number
RELEASES: In case of emergency, I give permission for my child to be treated as necessary at my expense. Pure Genius provides active, hands-on workshops. All reasonable attempts will be made to ensure your child’s safety. A child whose behavior endangers others or is not conducive to the workshop environment will be removed from the workshop without refund. Parents and guardians agree not to hold Pure Genius Educational Learning Center, Incorporated, Christine Celis, or any of their employees, agents, or representatives, responsible for any accidents or injuries that occur. Photos and videos of students and activities are taken during the workshops and they may be publicly shared and used in promotional materials. If you do not wish for your child to be photographed, please notify the instructor in writing, on or before the first workshop. Pure Genius is not licensed and is not required to be licensed by Bright From the Start. Pure Genius does carry liability insurance. All workshops must meet minimum enrollment or they will be cancelled. The aforementioned releases apply to all past/present/future enrollments. By clicking "Submit," I agree to these terms and conditions.

PLEASE NOTE: There is a maximum of 18 campers per session. A minimum of 8 campers must register or the camp will be cancelled.
Your child is not registered for camp until you pay in full. Since we limit each of our camps to 18 students in order to provide an optimal learning enviroment for your little genius, Pure Genius cannot "hold spaces" for any campers for any reason. Registration is on a first-come, first serve basis! You will be directed to pay via Paypal when you click "Submit." If you do not wish to pay via Paypal, please contact Pure Genius to set up other payment arrangements.

Please call (423) 385-5040 if you have any questions. THANKS!
Should be Empty:

2019 PURE GENIUS SUMMER CAMP REGISTRATION