Summer Camps Registration

Wild Roots Summer Camps - Eastern Sierra
Registration

Wild Roots Eastern Sierra Summer Camps are for children 3 to 6 years old.

Location: Community Gardens in Bishop, CA

Each session is Monday through Friday.
Each summer camp day is 8:45am-1:00pm.

Cost: $275 per session

Summer 2017

Session 1: June 5 - 9
Session 2: June 12 - 16
Session 3: August 21 - 25
Session 4: August 27 - September 1

How to Register:
1) Fill out and submit the form below, with a separate form for each child you are registering.
2) Make payment to secure your child's space.

Please note that your space is not secured until payment is received. It is advisable to make payment within 1-2 days of registering to secure your space as summer camp sessions can fill quickly. When a session fills to capacity, we will update the website asap, and we will open a waiting list.

Please send questions to Erin Boehme at erinwildroots@gmail.com

www.WildRootsSchool.org

REGISTRATION FORM

* Indicates required field

Child's Name *

First

Last

Child's Date of Birth *

Child's Age in July 2017 *

Parent / Guardian #1 Contact Info
Please share best contact info for the Parent / Guardian that is registering the child and will be the primary contact.

Parent / Guardian #1 Name *

First

Last

Email #1 *

Best Daytime Phone Number *

Additional Contact Info for Parent / Guardian #1 *

Parent / Guardian #2 Contact Info
Please share the best contact info for another Parent / Guardian as a secondary contact.

Parent / Guardian #2 Name *

Email #2 *

Best Day Time Phone Number #2 *

Additional Contact Info for Parent /Guardian #2 *

SUMMER CAMP SESSIONS

Session 1: June 5 - 9 *

Yes, Session 1

Session 2: June 12 - 16 *

Yes, Session 2

Session 3: August 21 - 25 *

Yes, Session 3

Session 4: August 27 - September 1 *

Yes, Session 4

HEALTH INFO

Does your child have any allergies or health concerns? *

yes no

If your child has any allergies or health concerns, please share more *

Has your child ever been stung by a bee? *

yes no

If your child has been previously stung, please share what the reaction was like. *

Does your child take any medication regularly? *

yes no

If your child does take regular medication, please share with us the type, what it is used for, how often the child takes the medication, and how long they have been taking it. *

Please share any social or emotional concerns you have for your child. *

Is there anything else you would like to share with us? *

TERMS

All camps run from 8:45 a.m. to 1:00 p.m.

The cost for each camp session is $275. Full payment must be received in order to hold your child's space in each camp session.

Cancellation Policy: Payment is refundable until two weeks prior to the first day of your session of camp, less a $50 cancellation fee. After that point, no refunds are available.

The undersigned also releases Wild Roots and its agents, from all claims which may develop or accrue to me, or the minor for whom this authorization is intended to benefit, on account of, or reason by of, any injury, loss, or damage which may be suffered by me or the minor as a result of the exercise of this consent and I hereby assume and accept the full risk and danger of any injury, hurt or damage that may occur as a result of the use of exercise of this consent.

I have read and understand the above Terms and agree to abide by these and all other Wild Roots Policies. *

Yes, I agree to the Terms

PAYMENT
Full payment must be received to hold your child's space in each camp session, unless a payment plan has been arranged with Wildroots.

$275 per session

Payment Methods

1) Pay by check or money order made out to "Wild Roots," mailed to 6163 Stow Canyon Road, Goleta, CA 93117.
Be sure to include a note/memo with your Child's Name and the Session/s you're securing.

2) Pay online with Google Wallet to wildroots.sb@gmail.com. Google Wallet allows you to pay with a debit card or a Google Wallet account. Be sure to include a note/memo with your Child's Name and the Session/s you're securing

Payment Amount Due and enter the total amount due here. *

Choose Your Payment Method *

Check or Money Order By Mail Online Payment with Google Wallet

Thank you for filling in your Registration for Wildroots Summer Camps, now please click Submit below.

Submit

Wild Roots Summer Camps - Eastern Sierra​Registration

Wild Roots Summer Camps - Eastern Sierra
Registration