Summer Camp Registration
Wilson's Rising Stars Youth Academy
Child's Name
*
First Name
Middle Name
Last Name
Suffix
(Child # 2)Child's Name
First Name
Middle Name
Last Name
Suffix
Child's date of birth
*
-
Month
-
Day
Year
Date Picker Icon
Child's Age
*
(Child #2) Child's Age
Gender
*
Male
Female
(Child #2) Gender
Male
Female
What grade will your child be in 2024/2025? (We will introduce some academics for your child's next school year once per week)
*
(Child #2) What grade will your child be in 2024/2025? (We will introduce some academics for your child's next school year once per week)
What size t-shirt does your child wear?
*
XS youth
S youth
M youth
L youth
Xl youth
S adult
M adult
L adult
Xl adult
Xxl adult
Xxxl adult
(Child #2) What size t-shirt does your child wear?
XS youth
S youth
M youth
L youth
Xl youth
S adult
M adult
L adult
Xl adult
Xxl adult
Xxxl adult
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother/Father/Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Father/Mother/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
Emergency contact (We will be using brightwheel for payments/attendance, please enter in any additional emergency contacts or individuals who may pick up child on that app, we will send you link to sign in/register)
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Name of person who may pick up child (identification required) (We will be using brightwheel for payments/attendance, please enter in any additional emergency contacts or individuals who may pick up child on that app, we will send you link to sign in/register)
*
First Name
Last Name
Relationship to child
*
Does your child have any special needs, medical conditions, medications or allergies? if yes, please explain. (If more than one child write the name and the special need next to the name.)
Wilson's Rising Stars Youth Academy staff may be videotaping and taking photographs of the children during the program. This documentation may be used in future brochures or posters as well as our social media sights or Web pages. This documentation may be used in presensations for the program. We would like your permission to include your child in these photographs.
*
Yes, you have my consent
EMERGENCY MEDICAL RELEASE: If emergency medical care is necessary and I cannot be reached, I authorize Wilson's Rising Stars Youth Academy to act in my behalf in granting permission for my child to receice emergency medical treatment. Parents are responsible for all expenses as the result of medical treatment.
*
Yes
No
Camp FEES. I understand that I will pay the following fees due every Friday, which is for camp for the following week. The first week's payment is due on or before the 1st day of camp. (No refunds for unused days or weeks of camp)
*
$110 per week 1 child
$210 per week 2 children
Special pre-determined discount
$200 per week special needs/behavioral problems
$525 entire summer, including registration ($650 savings: Not including activity fee, extended care, meals)
Meals. (No refunds for unused days or weeks of camp)
*
$15 per week Lunch, Breakfast & Snacks
$5 per week Breakfast & Snacks
Extended hours fees. (No refunds for unused days or weeks of camp)
*
$10 per week (Before 6:30-8:00)
$10 per week (After 5:00-6:30)
$20 per week Before & After
Extended hours are not needed
REGISTRATION FEE + Supplies. ( Early registration is through April 1) (Fee may be paid with link below, Registration Fee is Non-refundable)
*
$75 Early Registration
$125 Registration
$150 Late Registration Fee
$15 off per sibling for sibling discount
$525 Entire Summer Fee ($650 savings...Not including activity fee, meals or extended care.)
ACTIVITY FEE (Activity Fee is Non-refundable, as it will be used to pre-pay for trips/buses, etc.) The activity Fee Covers all field trips, transportation, special guests & special parties. Every other week we will have field trips. We will have a list of all field trips, you can pay for trips at least 2 weeks in advance. The fees most likely will not exceed $250 for the entire summer, but could be as little as $175 for the entire summer. We will email you once we have the final activity fee.
*
I understand
I understand that I may use cash app to make weekly payments, but there will be a 3.75% fee applied to cash app or paypal payments. Please include that fee in your payment. We will also use Brightwheel for payments this year.
Yes
Please type your full name in box, then sign below box.
*
Signature
*
Summer Camp Registration, please select one that applies to you.
prev
next
( X )
Summer Camp Registration
$
75.00
Quantity
1
2
3
Entire Summer (Including Registration Fee, Not Including activity Fee or extended care, meals)
$
450.00
This is a $650 Savings
Total
$
0.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Save
Submit
Should be Empty: