June 25-29, 2018- 9:00 am- 12 noon - Summer Camps at WGTC Murphy Campus
West Georgia Technical College- Murphy Campus, Waco, Ga
We are excited that your child will be participating in our Summer Camp Programs. To reserve your spot, please complete the information below and pay with Pay Pal or mail/drop off a check at the West GYSTC Center.
Email address *
Parent/Guardian Name
Your answer
Student Name
Your answer
Student's Current Grade Level
Your answer
Home Address
Your answer
Your answer
June 25-29, 2018- WGTC- Waco, GA- Murphy Campus
LEGO Camp* or Human Health Science Camp
*LEGO camps are rising 2nd grade-8th grade
Which camp would you like to register your child for?
Summer camps are $125 per person. Please select your payment method
Please remember that payment hold's your child's spot for the camp they are registered for.
Check the appropriate box below.
Please note additional comments or questions below.
Your answer
West GYSTC Waiver
I give permission for my child to participate in the Summer Camp or Saturday Science provided by West GYSTC, Inc. at University of West Georgia or West Georgia Technical College (Carrollton, Douglas or Murphy Campus). I understand that all activities will be planned and that all safety precautions will be taken during activities. In the event that an accident does occur, I will not hold West GYSTC, UWG, WGTC, their employees or volunteers responsible for any accidental injuries.
If emergency treatment or advice is considered necessary by the staff, I understand that the listed physician and parent or guardian will be notified. If you cannot be reached, you authorize arrangements of whatever emergency treatment is considered necessary including routine first aid care. I hold harmless and agree to indemnify WGTSTC, UWG, WGTC and the Board of Regents from any claims, causes of action, damages, and/or liabilities arising out of or resulting from said medical treatment. I acknowledge that I am solely responsible for any hospital or other costs arising out of any bodily injury or property damage sustained through my child’s participation in such voluntary program.
Physician's Name and Phone Number
Your answer
Please list any allergies, physical limitations, and special medications.
Your answer
Please Print/Sign Parent/ Guardian Name
Your answer
If you have any questions, please call Cathy at (770) 328-8530 or email at cfonteno@westga.edu
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of UWG. Report Abuse - Terms of Service