Full Day Camp Registration

Parent Name (required)

Your Email (required)

Student Name (required)

Camps you would like to sign up for

 June10-14 (Math 101 & Drama & English 101 & Rockets 101)
 June17-21 (English 201 & Messy Science & Math 102 & Magic)
 June 24-28 (English 101 & Drama & Study Skills & Rockets 201)
 July 8 - 12 (Spanish & Art & Math 201 & Music)
 July 15-19 (Math 202 & Magic & English 201 & Music)
 July 22 - 26 (English 101 & Journalism & Art & Messy Science)
 July 29 - Aug 2 (Robotics & English 201 & Math 101 & Rockets 201)
 Aug 5 - 9 (Math 201 & Robotics & Spanish & Journalism)
 Aug 12-16 (Study Skills & Math 202 & English 101 & Algebra)

My student will need extended care
 Mornings (8:00-9:00) Evenings (4:30-5:30)

My child is a
 New student Returning student
New students must fill out the information items below. All students must agree to our legal notice.

Grade (Fall 2013)

School

Street Address

City, State, Zip

Home Phone

Cell Phone

Emergency Contact

Medical Conditions

Food Allergies

$50 per camp deposit (non-refundable) is due within 3 business days of registration.

Select your method of deposit:
 Cash/Check/Credit Card in person (Come by during regular business hours)
 Check by mail (1271 S. Suber Rd, Greer, SC 29650)
 Credit Card over the phone (864)-244-2420

Select your method of payment:
 Cash/Check/Credit Card in person (Come by during business hours before the first day of camp)
 Cash/Check/Credit Card on the first day of camp (Pay when you drop your child off on Monday)
 Check by mail (Due one week before the start of the first camp you registered for) 1271 S. Suber Rd, Greer, SC 29650
 Credit Card over the phone (864)-244-2420

Your Message

Parent/Guardian Permission: As a legal guardian I give permission for the registrant to participate in all sessions for which registrant is signed up as well as any offsite activities. In an emergency, when the undersigned or other person named cannot be reached, I give permission for the Wired Minds’ staff to take any emergency measures deemed appropriate. It is understood that all reasonable efforts will be made to contact the parent/ guardian. All related expenses will be paid by me or my insurance.

I understand that when participating in a Wired Minds camp the registrant may be photographed for print, video or electronic imaging. I understand that the images may be used in promotional and fundraising materials, news releases and other published formats, and will be the sole property of Wired Minds.

I understand that I have signed my child up for a full day camp that runs from 9:00 am - 4:30 pm and I am responsible for providing lunch for my child. I understand that I am responsible for dropping off/picking up my child in a timely manner. I understand that if I did not sign my child up for extended care and I drop off/pickup my child more than ten (10) minutes earlier/later than the scheduled camp time that I may be charged a fee of $12 for 'unexpected extended care.'

Electronic signature