Christmas & New Years Camp Registration
Camp Timing: December 20-22 9 a.m. - 3 p.m. & December 27-29 9 a.m. - 3 p.m.
Camp Address: The Village School of Naples in Mr. Glen's room
Contact us at (407)466-0287 or Allison@SuperScienceFL.com
Email address *
Child's Name *
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Guardian's Name *
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Guardian's Email *
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Guardian's Phone Number *
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Emergency Contact 1 name and number *
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Emergency Contact 2 name and number
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What days will you attend? *
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Does your child need any medications administered while in our care? Yes or No (If yes, please write the details of your child’s medication needs below.) *
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Does your child have any allergies? Yes or No (If yes, please write the details below.) *
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Please check this box if your child requires special accommodations or additional assistance to be successful in this program.
Custodial Parent/ Legal Guardian Release:I have enrolled the above named child and my signature below indicates that I release Southwest Florida Performing Arts Center, Super Science and Amazing Art, and Educational Entertainment LLC, and any persons connected with the said organizations from blame or responsibility in case of accident or injury incurred during the operations of this program. There is no medical coverage included in this registration for any program offered by Super Science and Amazing Art. By participating in these programs, I assume medical insurance responsibilities. I understand that in the case of a medical emergency, 911 will be called and I hereby authorize the doctors at the designated hospital to treat my child for any injury or illness occurring during any Super Science and Amazing Art program. Super Science and Amazing Art and Southwest Florida Performing Art Center reserves the right to deny registration to any program and to charge fees where applicable. Further, I give full permission to any and all of the foregoing to use photographs, video tapes, recordings or any other record of this event for legitimate purposes. I understand refunds are available only if the class/program is changed or cancelled, excluding those cancelled due to an act of nature. Refunds will not be issued once a program has begun, unless accompanied by a medical excuse. NO refunds/credits will be given for missed days within a session. All requests must be submitted in writing and approved by administrative staff. *
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I understand that I will have to pay $$ upon arrival *
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