Spring Break Camp Application Form
Please fill out this form to enroll in our Spring Break Camp. A $100 non-refundable deposit is necessary to hold your spot. Payment must be made in full before the start of class. Payments can be made through our website, over the phone, or in the office. Please do not mail your payment as it may incur delays. The payment amount remains the same within the spring break camp regardless of changes in teacher, class structure, program, illness, absence, vacation, or any other reason your child may miss class. After payment is made there will be no refunds unless WSMC can't host the program.
Child's Full Name
Child's Age
Child's Date of Birth
Guardian's Full Name
Guardian's Full Name
Emergency Contact Phone Number
Additional Phone Number
Contact Email
Address
Please add the name and contact info for your child's Primary Health Care Provider
Medical Treatment Release. Are we allowed to:
Administer Minor First Aid Procedure
Administer Acetaminophen
Administer Benadryl
Administer Homeopathic Remedies
Transport you Child by Ambulance
Obtain Emergency Medical Care
Does your child have any allergies?
Photographs from camp participants or work may be used by WSMC in print or digital advertising, publicity or display.
I allow my child's image(s) to be used by WSMC in print, web and promotional materials.
I do not allow my child's image(s) to be used by WSMC.
How did you hear about the Spring Break Camp
Heartbeat Newsletter
Word-of-Mouth/Friends and Family
Social Media
WSMC Website
Local Newspaper
Other
I want to subscribe to the mailing list.
Hold Harmless
The FRP(s) agrees to release and hold harmless WSMC, its employees, trustees, and agents from all claims, damages or other liabilities for injuries to their child which are not the result of gross negligence by WSMC, its employees, trustees, and agents. The FRP(s) also agrees to pay WSMC for any damages or loss caused by their child to the School or School property. The School is not responsible for damage to or theft of personal property.
I agree to the terms & conditions.
Your Signature
*
Clear
Submit