Summer Camp Registration – Good Samaritan Academy

Good Samaritan Summer Camp Registration

This form can be used to register up to 3 campers as long as they are attending the same camps and share the same parent and approved pick up information.

Camper Information

Camper One Name *

First

Last

Camper One Age *

Does Camper ONE have any allerigies or medical conditions we should be aware of? *

If you selected '"YES" please explain in the box below.

Camper Two Name

First

Last

Camper Two Age

Does Camper TWO have any allerigies or medical conditions we should be aware of? *

If you selected '"YES" please explain in the box below.

Camper Three Name

First

Last

Camper Three Age

Does Camper THREE have any allerigies or medical conditions we should be aware of? *

If you selected '"YES" please explain in the box below.

Please select the weeks/months you would like your camper(s) to attend below

July Camps

Safari Spectacular -7/6 to 7/10
Splashtacular - 7/13 to 7/17
Under the Sea - 7/20 to 7/24
Digging for Dinosaurs! - 7/27 to 7/31

August Camps

County Fair - 8/3 to 8/7

Parent Information

Mom's Information

Mom's Name *

First

Last

Mom's Phone Number *

Mom's Email *

Dad's Information

Dad's Name *

First

Last

Dad's Phone Number *

Dad's Email *

Approved Pick Up List

Please list the people approved to pick up your child below. Government issued, picture ID required at pick up.

Approved Pick Up #1

First

Last

Approved Pick Up #2

First

Last

Approved Pick Up #3

First

Last

Approved Pick Up #4

First

Last

TERMS & CONDITIONS: *

By checking this box you acknowledge that you have read the following: Photographs, audio tapes or video tapes of me and/or my child may be taken by members of Good Samaritan UMC Faculty and Staff before, during or after camps while at Good Samaritan Camps. Said materials may be used for promotional purposes including newspaper, web site, advertising and other purposes for Good Samaritan UMC. Furthermore, I hereby consent that such information, sound, photographs, videos and files from which they are made shall be the property of Good Samaritan UMC. No names of students will appear on publicity.

Checkboxes *

By checking this box, you acknowledge that you have read the following: I will make payment by check/money order made out to "GSUMC" or by cash. I understand that if my child is registered for camp by the week fees are due no later than the Monday prior to the start of the camp week that is to be attended and that any payment received after the Wednesday prior to camp attendance will be subject to a late fee. I understand that if my child is registered for camp by the month fees are due no later than the first of the Month camp will be attended and any payment received after the 5th of the month may result in a late fee.

Checkboxes *

By checking this box you acknowledge that you have read the following: I understand that by registering online I am committing to making payment of the entire camp tuition. Should I wish to withdraw from camp, I understand that a WITHDRAWAL FORM must be submitted to Good Samaritan UMC, and that my withdrawal will take 10 business days to complete. Therefore, I will be liable for any tuition payments that are due within those 10 days.

Checkboxes *

By checking this box you acknowledge that you have read the following: I understand that each camper will be charged a $45 supply fee and that this fee must be paid prior to the a campers spot being held and is non-refundable regardless of the camper’s attendance.

To acknowledge that you understand, agree and consent to the terms and conditions above, please type "YES" into the following box and then click the "I agree" button to proceed with registering.

Single Line Text *

Name