Camper's Name *

First Name

Last Name

Camper's Birthday *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone *

(###)

###

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Parent/Guardian 2 Name *

First Name

Last Name

Parent/Guardian 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian 2 Phone *

(###)

###

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Consent *

I certify that I have read the Summer Camp Accident Waiver and Release of Liability Form, fully understand its contents, and agree to its terms. See bottom of form for link to Summer Camp Waiver and Release of Liability Form.

Cancellation & Refund Policies: Meadowsong and the summer camp instructors reserve the right to cancel any camp due to lack of enrollment, or for any other reasons. If Meadowsong or the instructor cancels the camp, you will be entitled to a full refund. Cancellations requested by June 1, 2025 will receive a refund less a $100 deposit per camper. No refund is available for cancellations after June 1, 2025. There are no refunds for missed days of camp, including cancelling a day of camp for severe weather. *

I agree with the Cancellation and Refund Policies.

As a parent or guardian of this child, I hereby consent to the use of photographs/video taken during the course of the session for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). *

Yes

No