Camp Registration Summer Camp 2021 Please submit a separate registration for each camper. Explorers must be potty trained before the start of camp. 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 InformationCamper First Name* Camper Last Name* Camper Goes By (If different than first name.)Birth Date* MM slash DD slash YYYY 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 InformationParent/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 PhoneHousehold 1 Home PhoneHousehold 1 Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 PhoneParent/Guardian 2 Work PhoneIs Household 1 the camper's primary address?* Yes No Would you like to add an additional household?* Yes No Household 2 InformationHousehold 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 PhoneHousehold 2, Parent/Guardian 1 Work PhoneHousehold 2, Home PhoneHousehold 2 Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 PhoneHousehold 2, Parent/Guardian 2 Work PhoneHealth and Emergency InformationPlease 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. Early Childhood Health Assessment Form (birth to 5) Health Assessment Form 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 PickupsPlease list the names and daytime phone numbers for any individuals (beyond guardians listed above) authorized to pick up your child from camp.PermissionsMedical 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.CampsPlease 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: $285.00 Quantity: Week 1June 28-July 2, CIRCUS & CLOWNS (EXPLORERS) Price: $0.00 Quantity: Week 2 is now FULL. Registration is closed.June 21-July 2, CIRCUS ARTS (ARTISTS) Price: $0.00 Quantity: Weeks 1 and 2 (2-week session) are now FULL. Registration is closed.July 5-July 9, SHELTERS & TUNNELS (EXPLORERS) Price: $0.00 Quantity: Week 3 is now FULL. Registration is closed.July 5-July 9, BUBBLES, SOAP, AND SALVES (ARTISTS) Price: $285.00 Quantity: Week 3July 12-July 16, BOATS, TRAINS & TRAVELING (EXPLORERS) Price: $0.00 Quantity: Week 4 is now FULL. Registration is closed.July 12-July 16, TIME CAPSULE CREATION AND STORIES (ARTISTS) Price: $0.00 Quantity: Week 4 Registration is closed.EXPLORERS, July 19-July 23 BUTTERFLIES, BUGS & BEES (EXPLORERS) Price: $0.00 Quantity: Week 5 is now FULL. Registration is closed.July 19-July 23, CHEMISTRY FUN AND GAMES (ARTISTS) Price: $285.00 Quantity: Week 5July 26-July 30, GROWING & GIVING (EXPLORERS) Price: $0.00 Quantity: Week 6 is now FULL. Registration is closed.July 26-July 30, LIFE IN THE FOREST (ARTISTS) Price: $285.00 Quantity: Week 6August 2-August 6, FAIRIES, KNIGHTS & DRAGONS (EXPLORERS) Price: $0.00 Quantity: Week 7 is now FULL. Registration is closed.August 2-August 6, ARCHERY (ARTISTS) Price: $0.00 Quantity: Week 7 is now FULL.August 9-August 13, LIFE IN THE WOODS (EXPLORERS) Price: $0.00 Quantity: Week 8 is now FULL. Registration is closed.August 9-August 13, ARCHERY (ARTISTS) Price: $285.00 Quantity: Week 8If 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. PaymentRefund PolicyCOVID-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 ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Billing Address* Same as Household 1 Enter New Address Billing Address Email Billing Address PhoneBilling Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CAPTCHANameThis field is for validation purposes and should be left unchanged.
