Wyoming Valley Experience: Summer 2024 REGISTRATION
We are excited to offer three great Wyoming Valley Experiences this summer!
  • Please read through the descriptions of our offerings. 
  • Locations, times, ages, and costs vary. 
  • Please sign up for a maximum of 2 camps. If we have vacancies, we will reopen registration. 
  • Please fill out a separate form for each participant. You do not need to reenter parent/ guardian and emergency contact info for additional children in the same household. Type a dash to skip that field. 
Direct all questions to Monica Kmak: wyomingvalleyexperience@gmail.com or text at 608-574-5625
Sign in to Google to save your progress. Learn more
Email *
Child's Name: first and last *
Child's age *
What school do you attend or are you home schooled? *
Are you interested in attending the youth session of Clay Camp? (at Adamah Art Studio) *
Captionless Image
Are you interested in attending the preteen/ teen session of Clay Camp?  (at Adamah Art Studio) *
Captionless Image
Are you interested in attending the Mystery Box Sculpture Challenge camp?(at Wyoming Valley School) *
Captionless Image
Are you interested in attending the Art-fullness Nature Experience?  (at Wyoming Valley School) *
Captionless Image
Parent/Guardian #1
Name: *
Relationship to child: *
Address: *
Phone Number: *
Email Address: (this is needed to receive registration confirmation and other information) *
I prefer to be contacted by: *
Parent/Guardian #2
Name:
Relationship to child:
Clear selection
Address (if different from above):
Phone Number:
Email Address:
Emergency Contact #1: name, ph#, relationship (not a parent or guardian) *
Emergency Contact #2: name, ph#, relationship (not a parent or guardian) *
Transportation, general info, and permissions
Please do your best to drop off and pick up your child in a timely manner. Our definition of timely is no more than 10 minutes before or after the session.  A late pick-up fee of $1 per minute will be charged for each minute a child remains in our care  beyond the 10 minute grace period. This fee covers the additional staff cost and ensures that our staff can leave on time. In the event of  unforeseen circumstances and occasional oversights, please contact Monica Kmak (608-574-5625)  as soon as possible.
Transportation will not be provided. Please indicate if you would like your email address shared with other families in order to coordinate carpools. *
Captionless Image
Name person picking up your child or indicate a need to carpool:
Should you need another person to pick up your child, please call and talk to Monica Kmak (608-574-5625) about the change.  Please understand that we cannot release your child to anyone without your prior approval. Please alert us to any security concerns.
Phone # of person picking up your child  or indicate a need to carpool:
Does your child have any allergies?  Please list.
Please list any health concerns we should be aware of.
What accommodations might we provide for your child so he/she has a safe and successful experience?
Behavior *
We expect students to be kind, safe and ready to learn to make this experience enjoyable for all.  If your child is unable to meet these expectations, his/ her/ their parents may be called immediately and asked to come pick him/her/them up.
Required
Clothing *
We will be outside every day. Please send your child with a hat or sunscreen. If the weather cooperates, we may have an opportunity for sprinklers, wading pool, or other activities involving water.  Please send your child with a towel and swimsuit.
Required
Food and beverage *
We ask all students to bring a full water bottle with them each day. They are also responsible for bringing their own snack and/ or lunch.
Required
Cost options *
Payment is due on the first day of camp at drop off. If you have requested a scholarship, your fee will be adjusted accordingly. *
Please make checks payable to Wyoming Valley Inc.
Clay camp (youth) $75
Clay camp (preteen/teen) $90
Mystery Box Sculpture Challenge $50
Art-fullness Nature Experience  $50
Required
Photography permission *
We will be sharing our photographs and/or video of activities and projects on Facebook. We will also be using pictures for grant applications, promotional materials, and newsletters.
I have read the above information and understand my responsibility. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy