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Registration formINSTRUCTIONS: Complete this application and health form and send it to the address below. Applications must be mailed in prior to April 1; after April 1, applications may be hand-delivered to the Summer Camp office. Completed Summer Programs health form and immunization record must accompany applications in order for your child to be registered. Faxed copies will not be accepted. Send a $100 non-refundable deposit per session for each child with your application. Make checks pay-able to The Westminster Schools and indicate the participant’s name on your check. You will receive a confirmation via email within 10-21 days. This statement will be your only reminder of the remaining balance due by May 1. Applications processed after May 1 must be accompanied by full payment. A $25 service charge is required for camp or session changes after May 1. No tuition refund is given after May 1. Registration for each camp ends on the Friday, one week before that camp begins. No applications will be accepted after that day. Include your deposit check: $100 per camper per session. Please try to group my child with (you may list ONE): Are either parent/guardian faculty or staff at Westminster? The undersigned, being a parent or legal guardian of the child requesting admittance or applying for a program myself, does hereby affirm that the applicant is in good health and suffers from no illness, disability, or condition that requires the taking of medication on a regular basis unless that condition is disclosed in the medical form. Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity. In the event of any accident or injury, I hereby give prior consent for pro-gram supervisors to procure any medical treatment deemed advisable on behalf of myself or my child. Every attempt will be made by the school to contact the parent or guardian in the event of an injury. I also irrevocably authorize The Westminster Schools and The Westminster Summer Programs to photograph, videotape or film my child for advertising, publicity, or any other lawful purpose. We will receive no compensation for such use and the undersigned hereby releases The Westminster Schools, The Westminster Summer Programs, and all employees of the school or programs from any and all liability from injury or illness, mental or physical, suffered by the participant during or related to program, unless caused by willful act or gross negligence. The undersigned also acknowledges hav-ing read the policies and terms of The Westminster Summer Programs. Additionally, the undersigned accepts financial responsibility for any equipment or property his/her child intentionally destroys while participating in the program. This form and our brochure are available on line at www.westminster.net/summer Please indicate the session(s) and program you are registering for: Choose 8, but you will only be scheduled for 6. Rank the choices from 1 to 8 with 1 being your first choice. SESSION 3: June 29-July 10 (Camp is open July 3) Ages 9-13 must check an activity schedule for each session enrolled. Rank your choices 1 to 3, with 1 being your first choice. Session 3: June 29-July 10 (Camp is open July 3) 4-year-old Half Day Program, 9:00 a.m.-12:30 p.m. 4-year-old Full Day Program ($640 per session) Rank schedule choices from 1 to 3 with 1 being your first choice. Priority is given by registration date. This section is for ages 9-13 only. LEADERSHIP IN TRAINING (Ages 14-15) $640 Camp Wildcats is a fun and unique adventure! Join us for art, tumbling, splash time, and so much more! Ages 10-18 Theatre Intensive features classes in Vocal Performance, Acting, Dance and a workshop on Broadway musical selections. No prior experience is necessary. Advanced Musical Theatre: June 1-June 19 , Ages 13-18 Academic Quiz Team Camp develops skills needed to succeed in competition and gives campers the op-portunity to play fast-paced academic games. No prior experience is necessary. Indicate the camp(s) you are registering for: All Sports Intensive Camps meet from 5:30 p.m.-8:30 p.m. and include a snack and sports drink every evening. SPECIAL SERVICES: BEFORE CARE AND AFTER CARE REGISTRATION Pay in full with registration—Drop off and pick up is at the camp on Nancy Creek Road Before Care / $100 per session / 7:00 a.m.-9:00 a.m.: breakfast, boardgames, interaction with our staff. Drop off between 7:00 a.m. and 8:30 a.m. After Care / $100 per session / 4:00 p.m-6:00 p.m.: afternoon snack, swimming, field games, board games, interaction with our staff. Pick up between 4:15 p.m. and 6:00 p.m. A fee of $1 per minute is charged for participants picked up after 6:00 p.m. Before Care and After Care is not available for Sports Intensive Camps Return COMPLETED Health Form and certificate of immunization with your application. Applications will not be processed without these forms. Do we have your permission to assist your child in taking: List any food allergies / dietary restrictions Medications or dietary supplements taken regularly List any health issues or significant health history which may limit participation I give my consent for Westminster employees, certified athletic trainers, nurses, staff members to use their best
judgment in securing medical aid and/or ambulance service in the event of a medical/dental emergency.
I certify that the information given on this Health Form is accurate to the best of my knowledge and that the child
listed above is in good physical health and may fully participate in all activities except as noted above.
Parent/Guardian SIGN HERE
A CERTIFICATE OF IMMUNIZATION MUST ACCOMPANY THIS HEALTH FORM, AS REQUIRED BY LAW.
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