CAMP REGISTRATION FORM Click for Camp Information Which Camp are You Registering For? * Little Explorers Summer Camp K-2 Grade STEM Summer Camp 3-4 Grade STEM Summer Camp 5-6 Grade STEM Summer Camp Tech Summer Camp (4-6 Grade) Engineering Summer Camp (4-6 Grade) Child's Name * First Name Last Name Child's Age * Known Allergies * Gurdian's Email * This will be used this to communicate updates, confirm registration, etc. Guardian Name #1 * First Name Last Name Phone * (###) ### #### Relation to Child * Guardian Name #2 First Name Last Name Phone (###) ### #### Relation to Child Please list ANY approved adult for child pickup: * The listed adults MUST bring a valid photo ID. We will not release your child to anyone who is not on this list. Photo Release * May we use your child’s photo in publicity photos? Yes No Liability Waiver * I/We, the undersigned, are the guardian(s) of the above named child and we agree, in taking advantage of this service provided by Discovery World on Market, a nonprofit organization under the laws of the State of West Virginia, to release and hold harmless Discovery World on Market, its officers, directors, agents, employees and volunteers, from any and all claims, demands, suits, costs and charges, in connection with or arising out of the child care service, including, but not limited to, bodily harm or injury to our children, except only for loss, harms or injury occasioned by gross negligence or intentional misconduct by the Discovery World on Market and/or its officers, agents, employees and volunteers and further authorize Discovery World on Market and/or its officers, agents, employees and volunteers to administer, or cause to be administered, at my/our sole cost and expense, medical treatment and/or medication to the above named child/children in the event of any emergency. I understand Electronic Signature * By signing, you acknowledge you have read and understood this form. First Name Last Name Thank you!
