WATW Christmas Camp Registration

Christmas Camp Registration

We are excited to celebrate this holiday season with your camper! Please fill out the registration form by November 28th to reserve your child's spot. As always, siblings are more than welcome to join in on our fun.
Camper's Information
Camper Name*
Age*
Please upload a recent photo of your camper.*

Browse Files
This photo will be used for staff and emergency purposes only. Cancelof
Camp Session Registering For? (SIBLINGS MAY ATTEND TOGETHER NO MATTER AGE FOR THIS CAMP)*
**please select the age group this child will be attending.
Allergies? Check all that apply *
Please list and explain any allergies

0/150
Agency Camper Attends*
NOTE: We are excited to welcome siblings, ages 3-17, this year to Camp! Please reserve a spot for each child attending by providing the name, age,session and T-shirt size. Have an older sibling (16+) who wants to lend a hand during camp? Please refer to the VOLUNTEER application.
Sibling's Information
Sibling Name
Age
Please upload a recent photo of your camper.

Browse Files
This photo will be used for staff and emergency purposes only. Cancelof
Camp Session Registering For? (ALL SIBLINGS MAY ATTEND THS CAMP TOGETHER)
**please select the age group this child will be attending.
Allergies? Check all that apply
Please list and explain any allergies

0/150
Sibling Name
Age
Please upload a recent photo of your camper.

Browse Files
This photo will be used for staff and emergency purposes only. Cancelof
Camp Session Registering For? ( ALL SIBLINGS MAY ATTEND THIS CAMP TOGETHER)
**please select the age group this child will be attending.
Allergies? Check all that apply
Please list and explain any allergies

0/150
Sibling Name
Age
Please upload a recent photo of your camper.

Browse Files
This photo will be used for staff and emergency purposes only. Cancelof
Camp Session Registering For? (ALL SIBLINGS MAY ATTEND THIS CAMP TOGETHER)
**please select the age group this child will be attending.
Allergies? Check all that apply
Please list and explain any allergies

0/150

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2*

*if applicable
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
Cell Phone

Emergency Contacts

Parents cannot be listed as emergency contacts. Please list the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of Bynum School, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact Information
Full Name*

First NameLast Name
Primary Phone Number*
Relationship to Child*

In the case of an emergency, do you give WE ARE THE WORLD DAY CAMP staff permission to seek immediate medical attention?*

YesNo
Please list all known medical conditions and/or diagnosis your child may have. Be as specific as possible so that we will be able to help make your child's camp enjoyable! *

0/150
How would you like us to handle the situation in the event of an medical episode. If your child has ever experienced seizures please include your action plan here.*

0/150
List any additional information about your child that would be useful for staff to know, such as fears, eating habits, or toileting needs. This information should not be medical, as that information should be included in the previous question.*

0/200
Check all that apply

Prescription medicationNonprescription medicationRefrigeration requiredTopical product or lotionTopical product or lotionFood supplementModified diet
Name of medication
Exact dosage
Behavior Agreement
The staff of WATW camp want to ensure your child’s camp experience is as enjoyable as possible. Camp is a group activity and we make every effort to work with your child’s needs to keep them engaged and cooperative with others. Aggressive behavior or poor group tolerance would result in the following hierarchy of intervention:

1. Reinforce appropriate behavior

2. Extinction (ignore the behavior and withholding reinforcement)

3. Verbal prompt to discontinue the behavior

4. Request to leave the area and take a break

5. Parent phone call

6. Removal for the day

7. If the behavior continues the following day, remove from camp for the current session.

We understand that every child will exhibit behavior, and that is accepted and expected. If your child has a specific behavior modification plan, or your child is highly reinforced by something, please let us know. To discuss a plan, behaviors, or concerns please contact Tawny Zachary directly at (806)831-5327
I agree to this behavior intervention plan and will adhere to it if my child demonstrates behavior during the session. I agree to discuss the behavior expectations with my child prior to the start of camp, so that he/she will be prepared to make "good choices"

Clear

Publicity Release for We Are The World Day Camp
Please select all that apply:*

I give my permission to the staff of WATW Camp to utilize photographs taken by staff.I do not want my child’s photograph to be used in any publicity by We Are The World Camp.
I agree that I have completed this form to the best of my ability.*

YesNo
I/we agree that We Are The World Day Camp/Bynum School and its staff shall not be liable for any damage arising from personal injury sustained by Camper during Camp or as a result of using We Are The World Day Camp/Bynum facilities. I/we assume full responsibility for any damages or injuries which may occur to Camper during the Camp session and hereby fully and forever discharge and hold harmless We Are The World Day Camp/Bynum School, its Trustees, staff, employees, volunteers, and agents (hereafter “Releasees”) from any and all claims, demands, damages, or causes of action, present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of the Camper’s participation in the Camp session and in the use of We Are The World Day Camp's facilities, including illness, injury, disability, death, loss of property other damage, even if arising from the negligence of Releasees.
Sign Document*
Date Signed*

MonthDayYear
For any questions, please contact Tawny Zachary, camp director at 806-831-5327 or wearetheworlddaycamp@gmail.com
Should be Empty:

Christmas Camp Registration

Camper's Information

Sibling's Information

Parents' Information

Parent/Guardian 2*

Emergency Contacts

Emergency Contact Information

Behavior Agreement

Publicity Release for We Are The World Day Camp