Portland Kinderschule 2018 Summer Camp Application and Agreement
Please complete this form and submit tuition amount of $200 per camp ($225 for science camp) to enroll your child in Portland Kinderschule's summer camp and secure a space. The early bird rate expired April 30.

Cancellations: There will be no refunds after May 1 unless an additional child enrolls in the same camp, in which case the refund will be equal to tuition paid minus $75 per camp.

Payment can be made via Zelle (e-mail cotreasurer@portlandkinderschule.com), bank transfer (contact us at info@portlandkinderschule.com for the account number), or check payable to Portland Kinderschule and mailed 2195 SW Vermont St. Portland, OR 97219.

PKS Summer Camps
Camp Descriptions:

1) Eine Reise in die Vergangenheit: (This camp is FULL but you can register for the wait list). Join us on a journey into the past where we will meet dinosaurs and cave people. Our campers will dig, explore, and get messy as we experience ancient life on our planet. Discover dinosaurs, enjoy prehistoric games and witness the power of volcanoes during this exciting time travel.

2) Bunte Experimente: (This camp is FULL but you can register for the wait list). Ready to learn all about colors with our in-house science teacher? This introduction to the world of colors is all about exciting hands-on experiments, demonstrations and art projects like tie-dye. Sign up for the most colorful summer week you've ever had!

3) Handarbeiten: Introduction to weaving, knitting and crochet. This camp is for boys and girls interested in exploring a wide range of handwork. We will weave, stitch and knit to create something personal to take home and actually use.

4) Wilde Kunst: Students will work with a wide range of different materials to create unique pieces of art and useful gadgets. Besides their individual creations, our campers will also work as a group on a big papier-mâché project. Be inspired!

Spaces will be filled on a first-come, first-serve basis. We will maintain a wait-list of interested families should a space become available at a later date. Space is limited to 10 children for science camp and 12 children for all other camps. Science camp is open to children ages 5-9; all other camps are open to children ages 4-9.

Part 1: Camp Selection
A 10% sibling discount applies to each additional child you enroll in the PKS Summer Camps. Sign up for 3+ weeks and receive 15% discount (no sibling discount with this option). Current PKS member families receive an additional 10% discount. Discounts are not given for missed days, vacation, illness or emergency closure.
Which camp(s) are you interested in registering your child for? *
Required
How do you plan to make your deposit/pay for the camp? (This helps us with accounting). *
Required
Part 2: Contact Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Name child prefers, if different from above
Your answer
Child's Birth Date *
MM
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DD
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YYYY
Parent/Guardian #1 Name *
Your answer
Parent/Guardian #1 Address *
Your answer
Parent/Guardian #1 Cell Phone *
Your answer
Parent/Guardian #1 Other Phone
Your answer
Parent/Guardian #1 E-mail *
Your answer
Parent/Guardian #1 Occupation/Employer *
Your answer
Parent/Guardian #2 Name *
Your answer
Parent/Guardian #2 Address (if different)
Your answer
Parent/Guardian #2 Cell Phone *
Your answer
Parent/Guardian #2 Other Phone
Your answer
Parent/Guardian #2 E-mail *
Your answer
Parent/Guardian #2 Occupation/Employer *
Your answer
How did you hear about Portland Kinderschule? *
Your answer
Part 3: Agreement
Parent/Guardian agrees to provide an immunization record for Student(s) prior to the beginning of camp. *
Parent/Guardian grants Portland Kinderschule the right to use all pictures and videos of Student(s) that may be obtained by Portland Kinderschule during any time Student(s) or any family members or guests of Student(s) are involved with school activities. *
Agreement and Release: Parent/Guardian warrants, represents, and agrees that Student(s) is in good physical and mental condition, and has no disability, impairment or ailment that would prevent Student(s) from engaging in all activities related to the classes for which he/she is registered. Parent/Guardian expressly agrees that participation in all of the Portland Kinderschule classes and facilities are at parent/guardian and Student’s sole risk. By signing this Agreement, Parent/Guardian waives, releases, and forever discharges Portland Kinderschule, its agents, employees, instructors, and/or staff for any and all injuries, damages, and/or loss which may be sustained by Student(s), any member of Parent/Guardian family, and/or any guests of Student or Parent/Guardian arising out of or connected with the use of any of the services or facilities of Portland Kinderschule or the premises on which Portland Kinderschule is located; Parent/Guardian further agrees that Portland Kinderschule is not liable for any demands, claims, damages, actions or causes of action whatsoever, to person or property, arising from or connected with such use. In addition, by marking "yes" Parent/Guardian hereby represents that Parent/Guardian has never been convicted of nor is under indictment for any crime involving violence or force or sex-related crimes involving a minor or adult. *
Parent/Guardian acknowledges that he/she has read and understands the Application and Agreement as stated above and agrees to its terms. (Please type name and date) *
Your answer
Part 4: Teacher Questionnaire
Child's birthplace *
Your answer
Is your child *
Please list any sibling names and ages *
Your answer
What are some of the reasons you would like your child to attend the Portland Kinderschule Summer Camp? *
Your answer
Which language(s) do you and the other parent speak with your child? *
Your answer
Does your child have special needs (learning, social, physical, emotional) that require assistance at school? *
Your answer
Part 5: Emergency Contact
Please list two people in addition to the parents/guardians listed above who are authorized to pick up your child from camp.
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Cell Phone *
Your answer
Emergency Contact #1 Other Phone
Your answer
Emergency Contact #1 Relation to child *
Your answer
Emergency Contact #1 Address *
Your answer
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Cell Phone *
Your answer
Emergency Contact #2 Other Phone
Your answer
Emergency Contact #2 Relation to child *
Your answer
Emergency Contact #2 Address
Your answer
Portland Kinderschule does not discriminate on the basis of race, color, ethnicity, gender, sexual orientation, disability, religion, language ability, or national origin.
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