Registration Form printable pdf download

Kids’ Camp 2014

Registration Form

□ Week 1: M-F, June 23 – 27

Week 5: M-F, July 28 – Aug 1

□ Week 2: M-F, June 30 – July 3 ( 4-‐days, $ 176)

□ Week 3: M-F, July 7 – 11

□ Week 4: M-F, July 14 – 18

Note: There will be no class: July 21 – 25.

First call ClayWays to reserve a space, then return this form ASAP with your payment.

Make checks payable to ClayWays or call 512-459-6445 to charge.

Sorry, there are no refunds after classes begin.

All camps are Monday to Friday from 8:30am to noon and $220 per person.

Week(s) you are registering for: ______________________________________

Please respect our age requirements. Your child must be at least 6 years of age for the younger kids’ camp and

11 years of age for the older kids’ camp by the start of the camp you are registering for.

Age group you are registering for:

______ Ages 6 - 10 ($220* per 1 week session)

______ Ages 11 and up ($220* per 1 week session)

Student’s Name: _________________________________________________________________

Age student will be at beginning of Camp :_______ Birth date:____/____/_____.

Parent’s Name(s): _____________________________________________________________

Mailing Address: _____________________________________________________________

__________________________________________ Zip:______________

Home Phone: _____________ Work Phone(s): (Mom) ______________(Dad)_____________

e-mail address _______________________________________________________________

How did you hear about ClayWays?_________________________________________

Medical Information:

Does your child have any allergies or special needs that we should be aware of? __________________

In case of Emergency, ClayWays should contact:

Name ___________________________________ Phone # ___________________________

In case of Emergency, ClayWays is authorized to seek medical attention from emergency services and/or:

Doctor __________________________________ Phone # ___________________________

Address _____________________________________________________________________

I understand that every precaution is taken to secure the safety of each student; however in case of an

accident, I agree to release ClayWays from any liabilities.

Signature ______________________________________Date______________________________

Registration Form