CAMPER’S NAME____________________________TOTAL # OF CAMPS________

Camp descriptions are available through the email sent to parents, on the parent portal, or on the Southland Academy web page (southlandacademy.org) under FORMS. Also, you can have printed copies upon request. Thank you for your support in the Southland Summer Camp Program.

TOTAL AMOUNT $__________________                                         CASH__________

CHECK_________

2019 Southland Academy Summer Camps Application

Please mark each camp that your child will attend.

Please use one form per child. Do not put more than one child on a form.

Remember to put the grade your child WILL BE IN NEXT YEAR!!

Camper’s Name_______________________________Rising Grade__________

Parent Contact #1 ______________________Contact #2____________________

                                                                Required                                                                                                 Required

Parent Email________________________________________________________

__________________________________________________________________

Parent Permission Signature for child to attend camp(s)

Payment Policy

Camp registration is not official until payment is received.

Refund Policy

Camp registration fees (less a $10.00 processing fee) will be refunded if notice of cancellation is received 3 days prior to the start of camp. Camp registration fees may not be reduced for late entry or early withdrawal unless due to illness or family emergency.

Waiver Policy

The registration form includes a waiver policy which must be completed and signed by the parent or guardian:

Waiver: I give permission for my child to attend the Southland Academy Summer Camp Program. I give permission to camp directors/instructors to seek treatment for my child should he/she become injured and I cannot be reached. I release The Southland Academy, its staff and the instructors of the Southland Academy Camp Program from responsibility for any injury.

Please print and sign your name on the line below.

Parent’s Printed Name _______________________________________________________

Parent’s Signature____________________________________________________________

Date:____________________________