One Day 2019 Imaginorium All-Ages Wizards Magic and Fun Academy Registration
This is the registration for The Imaginorium One Day Wizards Magic and Fun Academy, October 5, 2019 from 1-5 pm at All Souls Episcopal Church in Warwick, RI.
Email address *
Student's First Name *
This should be the name they primarily use in day to day interactions.
Your answer
Student's Last Name *
Your answer
Student's Legal name?
Sometimes a student has a different legal name from the one they use every day (because of a chosen name, nickname, etc.). For emergency purposes, if they are using a different name, please enter their full legal name here. If not, leave this blank.
Your answer
Preferred pronouns *
Student's Age *
(at the time of camp)
School Grade *
(or equivalent if home schooled)
Has your child attended our Wizarding Academy before, and if so, which one? *
Your answer
Wizarding Academy House *
If your child is new to our Wizarding Academy, which house do you think they would prefer? Rank from 1-4 with 1 being first choice. First choice is not guaranteed. Returning students stay in the same house, so please try to correctly list their house.
Captionless Image
1
2
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4
Waverider (blue, narwhal, water, peace)
Windhorse (green, pegasus, air, love)
Stonedragon (gold, dragon, earth, strength)
Phoenixfire (red, phoenix, fire, hope)
Does your child want to be in the same house or class as any other camper (siblings, friends)?
We will do our best, but we cannot guarantee this.
Your answer
Experience *
What is your child's experience with Harry Potter? Check all that apply.
Required
Parent(s) Name(s) *
Your answer
Mailing Address *
Your answer
City, State *
Your answer
Zip Code *
Your answer
Daytime Phone *
Where a parent or guardian can be reached in case of emergency
Your answer
FOOD ALLERGIES! *
We will not be eating lunch, but we will be providing some snacks. Are there any allergies we need to know about?
Your answer
Does your child have any other behavioral or health challenges? *
Your answer
Insurance Provider *
In case of a medical emergency, we will attempt to contact you immediately, but if it is a true emergency we will transport your child to the nearest emergency facility.
Your answer
Photo and Video Release *
(Initial) You may use photos and videos of my child on the web and in print to promote The Imaginorium. (We take care in how we share photos, especially of minors. It is VERY difficult to exclude children from photos, though it can be done if absolutely necessary. Talk to the Headmistress if you have concerns about how photos and videos are used.)
Your answer
Program Philosophy *
(Initial) I understand that The Imaginorium accepts and teaches diversity of race, religion, class, sexual orientation and gender identity and give permission for my child to attend this program.
Your answer
Permission *
By typing my name as an electronic signature, I represent that I am the Parent/Guardian of the child named in this registration. I grant permission for my child to participate in The Imaginorium Academy of Magic & Fun, October 5 from 1-5 pm. I agree and hereby do release and hold harmless all adult supervisors, from and for any and all liability which may arise for damages, loss or injuries, either to person or property, which my son/daughter may sustain while engaged in the activity conducted. I further agree to assume responsibility for any liability which may arise for damages, loss or injuries which may be caused by my son/daughter to the person or property of others. Should any injury occur, I grant permission for my son/daughter to receive treatment from an appropriate health care provider when the need for such treatment is immediate and when efforts to contact me (us) are unsuccessful. I also agree to pay and be responsible for all medical, hospital or other expenses which the Imaginorium or any/all supervisors may incur as a result of securing treatment.
Your answer
How did you hear about our program?
Your answer
A copy of your responses will be emailed to the address you provided.
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