Rock Painting Camp Registration
For K - 6th Grade
Student Information
Student's Name
*
First Name
Last Name
Grade COMPLETED in May 2025
*
K - 1st Grade
2nd Grade - 3rd Grade
4th Grade - 6th Grade
Sibling's Name ATTENDING Camp (optional)
First Name
Last Name
Grade Completed in May 2025 (optional)
K - 1st Grade
2nd Grade - 3rd Grade
4th Grade - 6th Grade
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent/Guardian Information/Emergency Contact
Name
*
First Name
Last Name
Cell Number
*
-
Area Code
Phone Number
E-mail
*
Confirm E-mail
*
example@example.com
Did you "Refer a Friend"? Please tell us the registered camper you invited who hasn't been to our Summer Reading Camp before!
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by (insert tutoring name here) during the selected camp. (insert tutoring name here) is not responsible for increased grades in school. However, we do guarantee providing each student with developmentally appropriate tasks, strategic lessons, and researched based content to improve their reading and/or math performance.
*
Agree
I do not agree
Media Disclosure
(insert tutoring name here) may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on (insert tutoring name here) Website, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children and their literacy work during classes. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at our Summer Reading Camp. You can also follow us on Facebook to capture all of the pictures yourself!
*
Agree
I do not agree
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.
Signature
Checkout
Registration includes registration fee AND camp date selection. Students are not enrolled until full payment is received. Discount for siblings will be applied at checkout.
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Credit Card Details
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Last Name
Credit Card Number
Security Code
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