Summer Camp Registration

Please use this form to register your child for summer camp 2021. If you have already registered this summer and would like to add additional weeks, please use this form.

Camper Information

* Required Information

Camper First Name*

Camper Last Name*

Camper Goes By

(If different than first name.)

Birth Date*

Camper Gender Identity*

Camper Pronouns*

Camper Ethnicity*

Hispanic/Latinx
Non-Hispanic/Latinx

Camper Race*

American Indian/Alaska Native
Asian
Black/African American
Hawaiian/Pacific Islander
Unknown
White

Is your child an HVWS student?*

Currently Enrolled (returning)
Currently Enrolled (new)
Past Student
Never Enrolled

Has your child attended our camp before?*

Yes (previous year)
Yes (already this summer)
No

Household 1 Information

Parent/Guardian 1 First Name*

Parent/Guardian 1 Last Name*

Parent/Guardian 1 Goes By

(If different than first name.)

Parent/Guardian 1 Relationship to Camper

Parent/Guardian 1 Pronouns

Parent/Guardian 1 Primary Email*

Parent/Guardian 1 Cell Phone*

Parent/Guardian 1 Work Phone

Household 1 Home Phone

Household 1 Address*

Street Address Address Line 2 City State ZIP Code

Would you like to add an additional parent/guardian to this household?*

Yes
No

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Goes By

(If different than first name.)

Parent/Guardian 2 Relationship to Camper

Parent/Guardian 2 Pronouns

Parent/Guardian 2 Primary Email

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Work Phone

Is Household 1 the camper's primary address?*

Yes
No

Would you like to add an additional household?*

Yes
No

Household 2 Information

Household 2, Parent/Guardian 1 First Name

Household 2, Parent/Guardian 1 Last Name

Household 2, Parent/Guardian 1 Goes By

(If different than first name.)

Household 2, Parent/Guardian 1 Relationship to Camper

Household 2, Parent/Guardian 1 Pronouns

Household 2, Parent/Guardian 1 Primary Email

Household 2, Parent/Guardian 1 Cell Phone

Household 2, Parent/Guardian 1 Work Phone

Household 2, Home Phone

Household 2 Address

Street Address Address Line 2 City State ZIP Code

Is Household 2 the camper's primary address?

Yes
No

Would you like to add an additional parent to this household?

Yes
No

Household 2, Parent/Guardian 2 First Name

Household 2, Parent/Guardian 2 Last Name

Household 2, Parent/Guardian 2 Goes By

(If different than first name.)

Household 2, Parent/Guardian 2 Relationship to Camper

Household 2, Parent/Guardian 2 Pronouns

Household 2, Parent/Guardian 2 Primary Email

Household 2, Parent/Guardian 2 Cell Phone

Household 2, Parent/Guardian 2 Work Phone

Health and Emergency Information

Please list any special needs, allergies, or medical issues about which we should be aware:*

Does your child require any medications?

Any medications must be clearly labeled and accompany the child to camp along with written instructions and permission to administer said medication.

Please list your child's doctor and phone number:

Please list your child's dentist and phone number:

My child has an updated Health Assessment Record on file.*

Yes
No

All families must submit a health assessment form that was completed by their child’s healthcare provider within three years of the last day of Summer Camp. If your child does not have a current health form on file, please submit one via e-mail to mperez@waldorfct.org or via fax to 203-364-0630.

Emergency Contacts*

Please list the names and daytime phone numbers for any individuals (beyond guardians listed above) we should contact in the case of an emergency.

Authorized Pickups

Please list the names and daytime phone numbers for any individuals (beyond guardians listed above) authorized to pick up your child from camp.

Permissions

Medical Release*

I hereby grant permission for the staff of HVWS to administer first aid should it become necessary while my child is in their care, and in the event that I cannot be reached in an emergency, I also give permission for my child's physician or dentist, hospital staff, or other emergency personnel to provide or secure treatment for, and/or hospitalize and/or order injections, anesthesia, or surgery for my child unless otherwise specified above. I give permission and understand that the Fire/Ambulance Department will provide emergency transportation to a hospital of their determination. I fully acknowledge and I will be responsible for any expense incurred on behalf of my child for said treatment.

Homeopathic Remedies

I authorize school personnel to administer homeopathic remedies.

Tick Removal

I give permission for HVWS and its representatives to attempt to remove any tick found on my child. Further, HVWS will not be held responsible or liable in any way for health-related problems and issues that may arise directly or indirectly from a tick bite or the removal of a tick from my child's body.

If possible, once removed, the tick will be placed in an envelope and labeled with the child's name, the location on the child where the tick was found, and the date and time the tick was removed and by whom. The envelope will then be given to the parent for further investigation.

COVID-19*

Our family will abide by any health and safety policies HVWS has in place in order to help stop the spread of COVID-19. These rules may apply to anyone on campus and may include, but are not limited to, mask-wearing and staying home when sick or during a quarantine required by either HVWS or local health officials.

Media Release*

I hereby grant permission to the Housatonic Valley Waldorf School (HVWS) to use at any time the likeness, and written or creative work of, and quotations from, my child, family, and myself, in informational or promotional material for HVWS, both in print and electronic media, without notice or monetary remuneration to myself, my family or my child.

If you have specific instructions regarding the media release policy please contact the Camp Director at mperez@waldorfct.org.

Camps

Please Select Camp Group*

Ages 3 to 8, EXPLORERS
Ages 9 to 14, ARTISTS

Please enter the number "1" in the field next to the week(s) for which you would like to register.

June 21-June 21, MUSIC & MERRIMENT (EXPLORERS)

Price: $275.00 Quantity:

Week 1

June 28-July 2, CIRCUS & CLOWNS (EXPLORERS)

Price: $275.00 Quantity:

Week 2

June 21-July 2, CIRCUS ARTS (ARTISTS)

Price: $570.00 Quantity:

Weeks 1 and 2 (2-week session)

July 5-July 9, SHELTERS & TUNNELS (EXPLORERS)

Price: $275.00 Quantity:

Week 3

July 5-July 9, BUBBLES, SOAP, AND SALVES (ARTISTS)

Price: $275.00 Quantity:

Week 3

July 12-July 16, BOATS, TRAINS & TRAVELING (EXPLORERS)

Price: $275.00 Quantity:

Week 4

July 12-July 16, TIME CAPSULE CREATION AND STORIES (ARTISTS)

Price: $275.00 Quantity:

Week 4

EXPLORERS, July 19-July 23 BUTTERFLIES, BUGS & BEES (EXPLORERS)

Price: $275.00 Quantity:

Week 5

July 19-July 23, CHEMISTRY FUN AND GAMES (ARTISTS)

Price: $275.00 Quantity:

Week 5

July 26-July 30, GROWING & GIVING (EXPLORERS)

Price: $275.00 Quantity:

Week 6

July 26-July 30, LIFE IN THE FOREST (ARTISTS)

Price: $275.00 Quantity:

Week 6

August 2-August 6, FAIRIES, KNIGHTS & DRAGONS (EXPLORERS)

Price: $0.00 Quantity:

Week 7 is FULL. Registration for this week is now closed.

August 2-August 6, ARCHERY (ARTISTS)

Price: $275.00 Quantity:

Week 7

August 9-August 13, LIFE IN THE WOODS (EXPLORERS)

Price: $0.00 Quantity:

Week 8 is FULL. Registration for this week is now closed.

August 9-August 13, ARCHERY (ARTISTS)

Price: $275.00 Quantity:

Week 8

If registering for archery, please indicate if your child is left handed or right handed.

Left
Right

If registering for archery, please enter your child's height.

Payment

Refund Policy
COVID-19
Parents will be asked to refer to a Daily Attestation of Health each day. Children who are sick or who are in quarantine should not attend camp.

If a camper must miss an entire week of camp due to illness or a close-contact quarantine, the Camp Director has the discretion to offer a later week of camp, space-permitting.
If a later week of camp is not available, the family will be issued a refund.
If a camper must miss a partial week of camp due to illness or a close-contact quarantine, the family will be issued a partial refund.
Refunds are not available for any required quarantine resulting from voluntary out of state travel. Our travel quarantine policy is subject to change at any time due to local conditions.

All-other Reasons

Refunds will not be given for days of camp missed for any reason other than those listed above.

Total

$0.00

Credit Card

American Express

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Same as Household 1
Enter New Address

Billing Address Email

Billing Address Phone

Billing Address

Street Address Address Line 2 City State ZIP Code

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Comments

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Camp Registration

Summer Camp 2021

Camper Information

Household 1 Information

Household 2 Information

Health and Emergency Information

Permissions

Camps

Payment