We're so glad you're joining us!
Get your capes ready and help us save the world! We can't wait to spend our summer doing good with you.
Start
 
Thanks for enrolling your child in Camp Super Hero! What is your first and last name? *

 
What is the first and last name of the child who will be attending Camp Super Hero? *

You'll have to register each child individually, but we promise to make it as quick and painless as possible!
 
Thanks {{answer_Q75L}}! Next we need to know how to reach you. What is your phone number? *

 
Home address? *

 
City? *

 
Zip code? *

 
Ok, back to the fun stuff. We can't wait to meet {{answer_GdJK}}. Where does your Super Hero go to school? *

 
What grade will {{answer_GdJK}} start in the fall of 2017? *

 
Which dates will {{answer_GdJK}} attend Camp? *


 
Thanks! Your total for Camp Super Hero is {{var_price}}. Would you like to pay online or mail a check? *

If you choose to mail a check, send to: Volunteer Center of Washington County
215 N. Main St., #111
West Bend, WI 53095
All payments must be received by Fri., June 16.

 
Your total for Camp Super Hero is {{var_price}}. Please enter your credit card information below. *

You will receive an email receipt for your purchase.
 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


 
We would always try to reach you first in the event of an emergency. However, who else can we call if we cannot reach you?

Please include first & last name, relationship, and phone number.
 
Almost done! We just need a little more information about your Super Hero. What size T-shirt does {{answer_GdJK}} wear? *

Shirts are unisex and available in adult sizes only.

 
Does {{answer_GdJK}} have any allergies? *


 
Please list allergies below & describe reaction. What is the treatment for this reaction?

 
Please list any past or present health concerns that we should be aware of (surgical, developmental, behavioral, psychological, etc.)

 
Is your child on any medication that will be required to be taken at camp?


 
Please provide instruction on how to Volunteer Center staff should administer medication.

 
Parents must agree to all terms in the waiver below the before child can attend camp.  Please read carefully before accepting. *

I understand that Camp Super Hero is being conducted by the Volunteer Center of Washington County, and that while attending Camp Super Hero, my child will participate in programs and activities offered by the Volunteer Center and its partner nonprofit agencies.

I understand that accidents and injuries may occur during participation in such activities, and that every reasonable effort will be made to provide reasonable care by the camp staff.

I hereby give permission for my child to attend Camp Super Hero and to fully participate in all camp programs and activities.

I hereby give permission for medical attention to be administered to my child by the camp staff in the event of a medical emergency. When I cannot be contacted, I hereby give my consent to have my child transported to a hospital emergency room, and the hospital medical staff has my authorization to provide any treatment, at my expense, that a physician deems necessary for the well-being of my child.

In exchange for the services provided my child at Camp Super Hero, I hereby waive, release and hold harmless the Volunteer Center of Washington County and its board members, employees, volunteers and nonprofit partners from and against any and all present and future claims, costs, liabilities, expenses, or judgments, including attorney’s fees and court costs, resulting from any damage, loss, personal injury or illness to my child and/or damage to my child’s property arising from or out of my child’s attendance or enrollment in, or out of my child’s participation in activities at our offered by the Volunteer Center and whether or not arising in whole or in part from any act or omission of the parties above released.

Media:  The Volunteer Center of Washington County has permission to use photographs and/or video of my child for promotional purposes.

Dismissal of Camper:  The Volunteer Center of Washington County reserves the right to dismiss, in its sole discretion, any camper whose behavior is deemed unsatisfactory or detrimental to the best interests of Camp Super Hero, other campers and/or staff, in which case no refunds will be made.

I HAVE READ AND FULLY UNDERSTAND ALL THE TERMS AND CONDITIONS AS EXPLAINED ON THIS PARENTAL CONSENT FORM AND GIVE PERMISSION AS OUTLINED ABOVE.
     
A confirmation email is headed your way! {{answer_GdJK}} is going to accomplish great things this summer. See you at Camp Super Hero!
Register another middle school child!
Powered by Typeform
Powered by Typeform