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The Arts at Angeloria’s, LLC Summer Day Camp Registration Form- Summer 2023
Campers entering grades 4-9 will have the unique opportunity to immerse themselves in a wizard’s world this summer. Learning from the best professors in subjects such as Defense Against the Dark Arts, Astronomy, Herbology, Care of Magical Creatures, Potions, Advanced Potions, Muggle Studies & Inventions, Orienteering, Moving Pictures, Photography, Advanced Moving Pictures, Theatre, Transfiguration/Metamorphosis, Ancient Medicine, Arithmancy, Hogwarts Atlas Explorations/ Marauders Maps, Study of Ancient Runes, Astronomy and more. In addition, campers will enjoy Quidditch matches, magical games, architecture, crafts, experiments, and more. In muggle talk- your child receives instruction in photography, architecture, engineering, chemistry, biology, theatre, fine arts, and more all wrapped up in a magical package! Camp hours: 8:30-3:30 Monday-Friday

Payment Option Information can be found on the lower portion of this form. Payments made by check must be received within one week of submission of registration form. Camp cost: $400 
$375 (Early Bird Special paid before February 15th)
10% additional sibling registrations
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Email *
For which camp(s) are you registering? *
Participant Last Name *
Participant First Name *
Gender *
Age *
Birthdate *
Present Grade in School: *
Street Address: *
Town/City/ State/Zip code *
Parent/Guardian #1 Name *
Parent/Guardian #1 Preferred Phone Contact Number *
Parent/Guardian #1 Preferred Email *
Parent Guardian #2 Name
Parent Guardian #2 Preferred Phone Contact Number
Parent Guardian #2 Preferred Email
Primary Alternate Emergency Contact/ Pick Up/Release Name *
Primary Alternate Emergency Contact/ Pick Up/Release Preferred Phone Contact Number *
Primary Alternate Emergency Contact/ Pick Up/Release Preferred Email *
Secondary Alternate Emergency Contact/ Pick Up/Release Name *
Secondary Alternate Emergency Contact/ Pick Up/Release Preferred Phone Contact Number *
Secondary Alternate Emergency Contact/ Pick Up/Release Preferred Email *
Health Insurance Provider *
Health Insurance Policy Number *
Pediatrician/Primary Care Provider Name *
Pediatrician/Primary Care Provider Phone *
Please list any medical issues, including any requiring maintenance medication i.e. Diabetic, Asthma, Seizures, etc.(If no medical issues exist, respond "None".) *
Please list any required treatment if medical issues were listed above. (If not, respond "None".)
Does your child have any allergies about which we should be aware? (If so, please explain. If not, respond "None.") *
Does your child have any restrictions related to physical activities about which we should be aware? (If so, please explain. If not, respond "None.") *
Are the Parent/Guardian and Alternate Contacts listed above the same individuals we should contact in the order listed in the event of a medical emergency? *
Do you understand that you and/or your alternate contact(s) will be notified in the case of a medical emergency involving your child? And, do you authorize that, in the event you cannot be reached, the calling of a doctor and the providing of necessary medical services in the event your child is injured or becomes ill? *
Do you understand that ​The Arts at Angeloria’s, LLC​ will not be responsible for the medical expenses incurred, but that such expenses will be your responsibility as parent/guardian? *
I hereby give permission for my child to be photographed during any ​The Arts at Angeloria’s, LLC​ sessions and/or events. I understand the photos will be used to keep a journal of activities, to share during presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of The Arts at Angeloria’s, LLC and its affiliates. ​ *
I hereby certify that all information on this application, and all information submitted as part of this application, is complete and accurate. The applicant has my approval to participate in all camp activities. I realize it is my responsibility to consult a physician to assess my child’s health relating to participation. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician​). *
I understand that the Summer Day Camp Program will take place at ​The Arts at Angeloria’s, LLC.​ Potential hazards to health and safety within the area include but may not be limited to: heat, poison ivy, bee stings, snakes, debris, tools and other camp items. I agree to hold harmless ​The Arts at Angeloria’s, LLC​ and do voluntarily release, waive, and relinquish all actions or causes of action for personal injury, property damage, or wrongful death occurring as a result of engaging in the activities during the camp experience. I agree that under no circumstances will I or my heirs, my child, executors, or administrators prosecute or present any claim for personal injury, property damage, or wrongful death pursuant against the ​ The Arts at Angeloria’s, LLC​ Summer Day Camp Program or their staff or against any other group, property owner, sponsor, other person or volunteer connected with the camp program for any of the said causes of action. ​ *
I understand that if ​The Arts at Angeloria’s, LLC​ camp staff determines that my child is not following directions to the point of creating a safety hazard for themselves or others, their enrollment may be terminated before the completion of the program and camp fees will not be refunded. I, the undersigned, acknowledge and agree that I have read the foregoing waiver release, have been advised of potential dangers incidental to my child engaging in camp activities and am fully aware of the legal consequences of signing this document. My child has permission to participate in ​The Arts at Angeloria’s​,​ LLC​ Summer Day Camp. ​ The Arts at Angeloria’s. LLC​ is not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or prorated. I understand that I may be required to pay an additional $20 for every half hour I am late for pick up of my child. *
Payment Method: *
Credit Card Payment Information (Please note: Square charges .15 + 3.5% per transaction.)
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Credit Card Payment Information: Name as it appears on card
Credit Card Payment Information: Card Number/Expiration Date/CVV/Zip Code
Name of parent/guardian completing this form *
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