Cabell County WV Science Adventures & NYSF Summer Camp Registration Form

Timer

--:--

* = required field

Some content may be updated based on selection

Email Address:

Child's Full Name:

Child's Academic Placement (as of Fall 2023, grade your child will be in)

Rising grades K-2 Morning Session 9AM-12PM

Rising grades 3-5 Afternoon Session 1PM-4PM

Child's Gender

Boy

Girl

Non-Binary

Parent/Guardian Name

Parent/Guardian Home/Cell Number

Parent/Guardian E-mail Address

Home Address

Emergency Contact Name (and relationship to the child)

Emergency Contact Phone Number

Special Considerations, Food Allergies, or Other Medical Considerations (Lunch/Snack is provided and food allergies will be accommodated. Some time at camps may be spent outdoors doing more physically strenuous activities).

Which Cabell County camp(s) are you registering:

July 10-14 Minecraft Madness

July 17-21 Animal Camp: From Tails and Scales and all the furs in-between

July 24-28 Lego City Imagination Camp

July 31 – August 4 Mini-Biologist Workshop Camp

Media Release: do you, as the legal guardian of the child being registered, grant permission for WV Science Adventures and NYSF to reproduce photographs taken of yourself and members of your family for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or any medium?

Yes, I grant permission

No, I do not grant permission

Liability Release: I understand that participation in the above event or activity could include actions or tasks which might be hazardous to the participant named above. By acknowledging below, I assume any risk of harm or injury which might occur to the participant due to his/her/my participation in the event or activity. I release the organization or business named above from all liability, costs and damages which might arise from participation in the above-named event or activity. If the participant is a minor, I agree that the minor has my consent to participate in the event or activity. I further provide my consent for the organization or business named above to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment

I acknowledge having read and consent to the liability release

Please wait for files to finish uploading