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summercamp23
admin
2023-05-24T17:12:17+00:00
Summer Camp 2023 Registration
Step
1
of
12
- Summer Camp Registration 2023
8%
High School - Boys / July 2- 10 / $640
High School - Girls / July 10- 18 / $640
Middle School - Boys / July 18- 24 / $480
Middle School - Girls / July 24- 30 / $480
Student Information
Student Name
(Required)
First
Last
Student Birth Date
(Required)
MM slash DD slash YYYY
Select Region
(Required)
Connecticut
Central New England (MA, RI)
East Pennsylvania (South Jersey, EPA)
New Jersey (North Jersey, Central Jersey)
New Hampshire
New York
Upstate New York
West Pennsylvania (Pittsburg, State College)
Student Gender
(Required)
Male
Female
Student Grade in May 2023
(Required)
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student Phone
(Required)
Student Email
(Required)
How many siblings will you register
(Required)
None
One Student
Two Students
Primary Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Student(2) Information
Student(2) Name
(Required)
First
Last
Student(2) Birth Date
(Required)
MM slash DD slash YYYY
Student(2) Gender
(Required)
Male
Female
Student(2) Grade in May 2023
(Required)
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student(2) Phone
(Required)
Student(2) Email
(Required)
Student(3) Information
Student(3) Name
(Required)
First
Last
Student(3) Birth Date
(Required)
MM slash DD slash YYYY
Student(3) Gender
(Required)
Male
Female
Student(3) Grade in May 2023
(Required)
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student(3) Phone
(Required)
Student(3) Email
(Required)
Parent / Guardian Information
Parent / Guardian Name
(Required)
First
Last
Parent / Guardian Phone
(Required)
Parent / Guardian Email
(Required)
Emergency Contact Information
Please list a contact that is not listed on this form, to be used if Parent / Guardian cannot be reached
Emergency Contact Name
(Required)
First
Last
Emergency Contact Phone
(Required)
Emergency Contact Email
(Required)
Relationship to Student
(Required)
Physician Info
Do you have a physician
(Required)
Yes
No
Physician Name
(Required)
First
Last
Physician Phone
(Required)
Health info
Is there any special medical or dietary needs for Student(1)
(Required)
No
Yes
Please list any medication the student needs, any allergies that you want us to be aware of and any dietary restriction that we would have to let our kitchen staff know.
Please list any medication the student needs, any allergies that you want us to be aware of and any dietary restriction that we would have to let our kitchen staff know. Student(1)
(Required)
Is there any special medical or dietary needs for Student(2)
(Required)
No
Yes
Please list any medication the student needs, any allergies that you want us to be aware of and any dietary restriction that we would have to let our kitchen staff know.
Please list any medication the student needs, any allergies that you want us to be aware of and any dietary restriction that we would have to let our kitchen staff know. Student(2)
(Required)
Is there any special medical or dietary needs for Student(3)
(Required)
No
Yes
Please list any medication the student needs, any allergies that you want us to be aware of and any dietary restriction that we would have to let our kitchen staff know.
Please list any medication the student needs, any allergies that you want us to be aware of and any dietary restriction that we would have to let our kitchen staff know. Student(3)
(Required)
Consent
Consent -Swimming Pool 1
I consent my child(Student 1) to swim in the swimming pool
Usage of swimming pool on the camp ground
Consent -Swimming Pool 2
I consent my child(Student 2) to swim in the swimming pool
Usage of swimming pool on the camp ground
Consent -Swimming Pool 3
I consent my child(Student 3) to swim in the swimming pool
Usage of swimming pool on the camp ground
Emergency Consent
(Required)
I have read and I agree to the policy.
I understand that in the event of an emergency affecting my child while participating in Sky Academy program, a designated employee of Sky Academy will contact me and inform me as soon as possible. In the event I cannot be reached, I hereby give permission for my child to be treated or hospitalized by a licensed physician or hospital selected by Sky Academy.
Camp Consent
(Required)
I have read and I agree to the policy.
By Submitting the form, I acknowledge the contagious nature of the Coronavirus/COVID-19. I further acknowledge that Sky Academy has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Sky Academy cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to mentors, administration, and fellow participants. I voluntarily seek services provided by Sky Academy and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days of the meeting day.
* I have not traveled to a highly impacted area within UNITED STATES in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.
* I am following all government recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Sky Academy harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Sky Academy. I understand that this release discharges Sky Academy from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, drawn, medical treatment, or property damage that may arise from, or in connection to, any services received from Sky Academy. This liability waiver and release extends to the salon together with all owners, partners, and employees. Assumption of Risk and Waiver of Liability: In consideration of the above, I assume all risks associated with the preparation of food products supplied under this Agreement, including matters of health and safety associated thereof. I do hereby release, waiver, discharge, and covenant not to sue Sky Academy, and their respective Trustees, officers, employees, students and agents from liability from any and all claims including the negligence of said organizations and their respective Trustees, officers, employees and agents, resulting in personal injury, accident, or illness, including death and property loss arising from any and all food products provided under this Agreement. By registering to the Summer Camp hosted by Sky Academy.
I also consent to and acknowledge that I may be photographed/recorded at all times before, during, and after the event by the Sky Academy staff for promotional and interorganizational purposes.
Transportation
New Jersey - Transportation
(Required)
Price:
$65.00
New York - Transportation
(Required)
Price:
$80.00
Central New England - Transportation
(Required)
Price:
$150.00
Transportation Consent
(Required)
I understand that my local organization will be providing me a transportation service with the price listed above.
You have selected to pay later, please keep in touch with Sky Academy in regards of making your payment
Daha sonra ode seceneginiz icin tesekkur ederiz. lutfen odeme icin Sky Academy kurumu ile iletisimde kaliniz.
Cash Consent
(Required)
I agree to the privacy policy.
I consent that my registration is not final until I make my payment to the requested organization.
Payment
Hidden
High School - Boys / July 2- 10 / $640
High School - Boys
(Required)
Price:
High School - Boys (Sibling Discount)
(Required)
Price:
High School - Boys 2 (Sibling Discount)
(Required)
Price:
High School - Boys 3 (Sibling Discount)
(Required)
Price:
Hidden
High School - Boys(Juniors) / July 2- 10 / $640
High School - Boys(Juniors)
(Required)
Price:
High School - Boys / Juniors (Sibling Discount)
(Required)
Price:
High School - Boys / Juniors 2 (Sibling Discount)
(Required)
Price:
High School - Boys / Juniors 3 (Sibling Discount)
(Required)
Price:
Hidden
High School - Girls / July 10- 18 / $640
High School - Girls
(Required)
Price:
High School - Girls (Sibling Discount)
(Required)
Price:
High School - Girls 2 (Sibling Discount)
(Required)
Price:
High School - Girls 3 (Sibling Discount)
(Required)
Price:
Hidden
Middle School - Boys / July 18- 24 / $480
Middle School - Boys
(Required)
Price:
Middle School - Boys (Sibling Discount)
(Required)
Price:
Middle School - Boys 2 (Sibling Discount)
(Required)
Price:
Middle School - Boys 3 (Sibling Discount)
(Required)
Price:
Hidden
Middle School - Girls / July 24- 30 / $480
Middle School - Girls
(Required)
Price:
Middle School - Girls (Sibling Discount)
(Required)
Price:
Middle School - Girls 2 (Sibling Discount)
(Required)
Price:
Middle School - Girls 3 (Sibling Discount)
(Required)
Price:
Coupon
Total
Hidden
Payment
Payment Method
*
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
Page load link
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