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Summer Camp 2022 Registration Page
Sam Faeder
2022-03-18T17:09:06-04:00
Summer Camp 2022 Registration Form A
Parent Full Name
*
Parent Email
*
Parent Phone
*
Child's Name
*
Child's Date of Birth
*
Month
Day
Year
Child's School
*
Sibling(s): Please Add Name, DOB, and Week(s) Attending
If you would like to add a sibling(s) registration, please do so here, along with their DOB and week(s) attending. We will contact you for additional payment, with all sibling discounts for all children, at a later date.
Child[ren]'s Allergies (or write "none")
*
Additional Information About Your Child[ren]
Week A (June 13th - June 17th) (NEW!)
Monday, June 13th
Tuesday, June 14th
Wednesday, June 15th
Thursday, June 16th
Friday, June 17th
Full Week A (June 13th-17th) (Single Week)
Full Week A (June 13th-17th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 0 (June 20th - June 24th)
Monday, June 20th
Tuesday, June 21st
Wednesday, June 22nd
Thursday, June 23rd
Friday, June 24th
Full Week 0 (June 20th-24th) (Single Week)
Full Week 0 (June 20th-24th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 1 (June 27th - July 1st)
Monday, June 27th
Tuesday, June 28th
Wednesday, June 29th
Thursday, June 30th
Friday, July 1st
Full Week 1 (June 27th-July 1st) (Single Week)
Full Week 1 (June 27th-July 1st) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 2 (July 5th - July 8th)
Tuesday, July 5th
Wednesday, July 6th
Thursday, July 7th
Friday, July 8th
Full Week 2 (July 5th-8th) (Single Week)
Full Week 2 (July 5th-8th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 3 (July 11th - July 15th)
Monday, July 11th
Tuesday, July 12th
Wednesday, July 13th
Thursday, July 14th
Friday, July 15th
Full Week 3 (July 11th-15th) (Single Week)
Full Week 3 (July 11th-15th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 4 (July 18th - July 22nd)
Monday, July 18th
Tuesday, July 19th
Wednesday, July 20th
Thursday, July 21st
Friday, July 22nd
Full Week 4 (July 18th-22nd) (Single Week)
Full Week 4 (July 18th-22nd) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 5 (July 25th - July 29th)
Monday, July 25th
Tuesday, July 26th
Wednesday, July 27th
Thursday, July 28th
Friday, July 29th
Full Week 5 (July 25th-29th) (Single Week)
Full Week 5 (July 25th-29th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 6 (August 1st - August 5th)
Monday, August 1st
Tuesday, August 2nd
Wednesday, August 3rd
Thursday, August 4th
Friday, August 5th
Full Week 6 (August 1st-5th) (Single Week)
Full Week 6 (August 1st-5th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 7 (August 8th - August 12th)
Monday, August 8th
Tuesday, August 9th
Wednesday, August 10th
Thursday, August 11th
Friday, August 12th
Full Week 7 (August 8th-12th) (Single Week)
Full Week 7 (August 8th-12th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 8 (August 15th - August 19th)
Monday, August 15th
Tuesday, August 16th
Wednesday, August 17th
Thursday, August 18th
Friday, August 19th
Full Week 8 (August 15th-19th) (Single Week)
Full Week 8 (August 15th-19th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 9 (August 22nd - August 26th)
Monday, August 22nd
Tuesday, August 23rd
Wednesday, August 24th
Thursday, August 25th
Friday, August 26th
Full Week 9 (August 22nd-26th) (Single Week)
Full Week 9 (August 22nd-26th) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Week 10 (August 29th - September 2nd)
Monday, August 29th
Tuesday, August 30th
Wednesday, August 31st
Thursday, September 1st
Friday, September 2nd
Full Week 10 (August 29th-September 2nd) (Single Week)
Full Week 10 (August 29th-September 2nd) (Multiple-Week Discount)
If signing up for 2+ full-weeks of camp, select "Multiple-Week Discount." If signing up for 1 full-week of camp, select "Single Week"
Early Drop-Off (Full Weeks)
Price:
$40.00
Quantity:
Please write the number of total WEEKS you would like early drop off in the quantity field
Early Drop-Off (Single Dates)
Price:
$10.00
Quantity:
If registering for drop-in dates (instead of full weeks) for early drop-off, please write the number of total DAYS you would like early drop off in the quantity field
After-Camp (Full Weeks)
Price:
$175.00
Quantity:
Please write the number of total WEEKS you would like after-camp in the quantity field
After-Camp (Single Dates)
Price:
$40.00
Quantity:
If registering for drop-in dates (instead of full weeks) for after-camp, please write the number of total DAYS you would like early drop off in the quantity field
Early Drop-Off / After-Camp - Additional Details
If registering for early-drop off or after-camp for part of your summer camp registration (and not the entire registration), please list dates here. Early Drop-Off is from 8:30am-9:00am. After-Camp is 3:00pm-6:00pm. Please register for ED/AC using the fields above.
How Did You Hear About Us?
Monday, June 13th
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Thursday, June 23d
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Friday, June 24th
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Monday, June 27th
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Monday, July 18th
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Monday, August 1st
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Monday, August 22nd
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Monday, August 29th
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Wednesday, August 31st
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Thursday, September 1st
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Friday, September 2nd
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Full Week A (June 13th-17th) (Single Week)
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Full Week A (June 13th-17th) (Multiple-Week Discount)
Price:
Full Week 0 (June 20th-24th) (Single Week)
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Full Week 0 (June 20th-24th) (Multiple-Week Discount)
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Full Week 1 (June 27th-July 1st) (Single Week)
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Full Week 1 (June 27th-July 1st) (Multiple-Week Discount)
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Full Week 2 (July 5th-8th) (Single Week)
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Full Week 2 (July 5th-8th) (Multiple-Week Discount)
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Full Week 3 (July 11th-15th) (Single Week)
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Full Week 3 (July 11th-15th) (Multiple-Week Discount)
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Full Week 4 (July 18th-22nd) (Single Week)
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Full Week 4 (July 18th-22nd) (Multiple-Week Discount)
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Full Week 5 (July 25th-29th) (Single Week)
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Full Week 5 (July 25th-29th) (Multiple-Week Discount)
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Full Week 6 (August 1st-5th) (Single Week)
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Full Week 6 (August 1st-5th) (Multiple-Week Discount)
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Full Week 7 (August 8th-12th) (Single Week)
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Full Week 7 (August 8th-12th) (Multiple-Week Discount)
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Full Week 8 (August 15th-19th) (Single Week)
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Full Week 8 (August 15th-19th) (Multiple-Week Discount)
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Full Week 9 (August 22nd-26th) (Single Week)
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Full Week 9 (August 22nd-26th) (Multiple-Week Discount)
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Full Week 10 (August 29th-September 2nd) (Single Week)
Price:
Full Week 10 (August 29th-September 2nd) (Multiple-Week Discount)
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Total
$0.00
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Consent
*
I agree to the waiver of liability
I, the parent/guardian registering my child[ren] for a Mindful Sports program, am aware that participation in youth sports programs has some inherent risks and injury can occur. On rare occasions these injuries can be serious. In consideration of my child[ren] being allowed to participate in Mindful Sports programs, I, the parent/guardian, assume the risk of participation and agree not to hold Mindful Sports, the program directors, coaches, assistant coaches, or owner responsible for any and all injuries caused by or resulting from participating in Mindful Sports Programs. I understand that this program is taking place during a time when Coronavirus presents additional risk. I understand these risks. In the event of any injury or illness caused directly or indirectly by Coronavirus or any such virus, I will not hold Mindful Sports, and all associated parties previously mentioned, responsible. By selecting the "I agree" button above, I state that I understand this description and agree.
Consent
I agree to the permission for photographic likeness
I, the parent/guardian registering my child for a Mindful Sports program, authorize the use of pictures of the above-named child participant to be posted on the Mindful Sports website or advertising and social media published by Mindful Sports
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