WMACS Summer Camp Registration

Parent Information

Parent 1 Name *

First

Last

中文姓名 *

Cell Phone *

Email *

Parent 2 Name

First

Last

中文姓名

Cell Phone

Email

Home Phone

Priority *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Medical Information

Insurance Company *

Policy *

Group ID

Member ID *

Emergency Contact *

Phone *

Doctor Name *

Doctor Phone *

Total Campers *

1 Camper
2 Campers
3 Campers

Camper Information

Camper #1 Name *

First

Last

Camper #1 中文姓名 *

Camper #1 Cell Phone

Camper #1 Email

Camper #1 Date of Birth *//

Camper #1 Gender *

Male
Female

Camper #1 Roommate Request

Camper #1 US School *

Camper #1 Grade *

Camper #1 中文学校

Camper #1 年级

Camper #1 Allergy

Camper #1 Medication

Camper #1 Physical Limitations

Camper #1 T-shirt Size *

Camper #1 Photo Upload *

Photo format accepted: jpg(jpeg), gif, png. Size limit: 5 MB Camper photo must comply with standard passport photo specs and especially size and background. Rename file name to match camper's name before upload.

Camper #2 Name *

First

Last

Camper #2 中文姓名 *

Camper #2 Cell Phone

Camper #2 Email

Camper #2 Date of Birth *//

Camper #2 Gender *

Male
Female

Camper #2 Roommate Request

Camper #2 US School *

Camper #2 Grade *

Camper #2 中文学校

Camper #2 年级

Camper #2 Allergy

Camper #2 Medication

Camper #2 Physical Limitations

Camper #2 T-shirt Size *

Camper #2 Photo Upload *

Photo format accepted: jpg(jpeg), gif, png. Size limit: 5 MB Camper photo must comply with standard passport photo specs and especially size and background. Rename file name to match camper's name before upload.

Camper #3 Name *

First

Last

Camper #3 中文姓名 *

Camper #3 Cell Phone

Camper #3 Email

Camper #3 Date of Birth *//

Camper #3 Gender *

Male
Female

Camper #3 Roommate Request

Camper #3 US School *

Camper #3 Grade *

Camper #3 中文学校

Camper #3 年级

Camper #3 Allergy

Camper #3 Medication

Camper #3 Physical Limitations

Camper #3 T-shirt Size *

Camper #3 Photo Upload *

Photo format accepted: jpg(jpeg), gif, png. Size limit: 5 MB Camper photo must comply with standard passport photo specs and especially size and background. Rename file name to match camper's name before upload.

Payment

We agree to pay the following fees:

Registration Fee: $50 per family

Regsitration Fee

Camp Fee *

1 Camper
2 Campers
3 Campers

Including 8 days 7 nights lodging, meals, tuition, materials, camp T-shirt, reunion, and charter bus transportation. Now - 04/30 $730.00; 05/01 - 06/30 $795.00; 07/01 - 07/05 (Deadline) $850.00.

Camp Fee *

1 Camper
2 Campers
3 Campers

Including 8 days 7 nights lodging, meals, tuition, materials, camp T-shirt, reunion, and charter bus transportation. Now - 04/30 $730.00; 05/01 - 06/30 $795.00; 07/01 - 07/05 (Deadline) $850.00.

Camp Fee *

1 Camper
2 Campers
3 Campers

Including 8 days 7 nights lodging, meals, tuition, materials, camp T-shirt, reunion, and charter bus transportation. Now - 04/30 $730.00; 05/01 - 06/30 $795.00; 07/01 - 07/05 (Deadline) $850.00.

Total

$ 0.00

Payment Address

Make check payable to WMACS. With camper names on the check. Print this form before submitting. Mail check and the completed form to WMACS, 11634 Chapel Road, Clifton, VA 20124

Signature

By submitting this registration form: The parents/guardian (We), and kids listed above (Camper), by digitally signing below, hereby

a. agree WMACS Summer Camp (The Camp) assumes no liability for injury or damage arising from the results of participation.

b. understand all activities present inherent risk and hazards, which the Camper are urged to consider and which the Camper assume.

c. approve Camper to participate in this Camp and consent to emergency treatment.

d. will consult a physician regarding any concerns before registering the Camp.

e. certify that to the best of our knowledge, all the medical concerns, including allergy for food (including, but not limited to, peanuts, milk, etc.), and medicine, are listed above for the reference of Camp counselors and staff.

f. certify all info provided are true.

g. grant the Camp and all persons acting under its permission or authority, the right to use, reproduce, assign and distribute photographs, video/audio liability involving the Camper, for use in materials that Camp may compile and distribute.

h. discharge and agree to save harmless the Camp, its legal representatives or assigns, and all persons acting under its permission or authority, from any liability whatsoever for any claims of any nature which may arise out of Camper's participation at the Camp.

i. understand and agree that the Camp reserve the right to reject any registration submitted.

j. agree the terms and conditions set forth for registration and withdrawal.

k. agree the simplified Chinese characters in the name may be converted into traditional Chinese for use on certificates/souvenir, etc.

Parent Digital Signature *

Please note, simply click down and drag your cursor to write your name. Name entered here must be same as one of the parents' name, or the registration will be voided. Make sure all info shown are complete and correct. You should print this form before submitting. After submitting changes will be limited.