Home

Behind the Scenes

Donate

Contact

REALLY BIG FIELD TRIP

Registration

Parent/Guardian Permission Statement

By registering, I hereby give my child permission to attend Kids and Cultures Camps. I authorize the staff/volunteers of Kids and Cultures and Your Language Connection to take and use photographs and audio/video footage of my child as needed for their records and/or publicity programs. I hereby give permission for my child to be transported by Camp personnel or by ambulance for emergency treatment, as deemed necessary by Camp personnel. I accept all responsibility to carry insurance for injuries and health-related claims for my child. I hereby release Kids and Cultures, Your Language Connection, and the host location from all legal liability for my child.

Payment

To reserve your child's space, please send non-refundable deposit of $50 per week per child registered within two weeks of registering (or you may pay the entire amount at this time). The balance of the registration fee is due by May 17, 2010. A late fee of $15 per child will be added if the balance is not received by May 17, 2010.

Please send a check payable to Kids and Cultures, with your child's name in the memo line, to Kids and Cultures, 823 N. Duke St., Lancaster, PA 17602.

Cancellation/Refund

If your registered child is unable to attend Camp, notify us immediately in writing. If you cancel by May 17, 2010, a full refund (less the deposit) will be issued in the form of a credit for a future Camp session. There will be no refunds/credits issued after May 17, 2010, except in the case of an emergency.

Thank you!

Kids and Cultures Camp: For Which Session Are You Registering?

Your Language Connection Spanish Camp:

* Child's Name (First and Last):

* New or Returning Camper:

* Boy or Girl:

* Date of Birth (Month-Day-Year):

* Grade Completing:

Allergies and/or special conditions:

* Child's physician or source of medical care (name and phone number):

* T-Shirt Size:

Additional Child's Name (First and Last):

New or Returning Camper:

Boy or Girl:

Date of Birth (Month-Day-Year):

Grade Completing:

Allergies and/or special conditions:

Child's physician or source of medical care (name and phone number):

T-Shirt Size:

Additional Child's Name (First and Last):

New or Returning Camper:

Boy or Girl:

Date of Birth (Month-Day-Year):

Grade Completing:

Allergies and/or special conditions:

Child's physician or source of medical care (name and phone number):

T-Shirt Size:

* Parent/Guardian's Name:

* E-mail Address
(A copy of the completed registration form will be sent to this address):

* Daytime Phone:

* Evening Phone:

Cell Phone:

* Address:

* City:

* State:

* Zip:

* Name of Emergency Contact (used only if we cannot reach you):

* Emergency Contact's Daytime Phone:

Emergency Contact's Cell Phone:

How did you hear about Kids and Cultures Camp?

Is there anything else that Camp directors and staff should know
about your child?

Any Additional Comments or Questions:

Promotion Code:

Bring A Friend: Name of camper you invited or who invited you:

Additional amount we will contribute to the Camp Scholarship Fund:

spam captcha
Security Code:

Registration

Website sponsor