Registering for Summer CampStep 1: Register*After completing registration, you will be redirected to purchase your camp. Thank you. First Child's Name * First Name Last Name Birthdate * MM DD YYYY Gender * Male Female Non-Binary Prefer not to say Is your child 6 years or older? * Age requirement is 6+ Yes No Child's School If signing up more than one child, please fill out information below. Second Child's Name First Name Last Name Birthdate MM DD YYYY Gender Male Female Non-Binary Prefer not to say Is your child 6 years or older? Age requirement is 6+ Yes No Child's School Parent or Guardian Information Primary Contact Name * First Name Last Name Email * Phone Numbers (Home, Cell, Work) * List primary contact's phone numbers. Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name * Emergency Contact Phone * Authorized Pickup List names and phone numbers of people who you authorize to pickup your child (other than you) Emergency Medical Information PERMISSION IS GIVEN TO ONE WITH HEART FOR THE FOLLOWING: IN AN EMERGENCY, ONE WITH HEART HAS MY PERMISSION TO OBTAIN MEDICAL TREATMENT FOR MY CHILD, CALL AN AMBULANCE OR TRANSPORT MY CHILD TO ANY AVAILABLE PHYSICIAN OR HOSPITAL AT MY EXPENSE, WITH THE FOLLOWING RESTRICTIONS (IF APPLICABLE) MY CHILD MAY BE GIVEN MEDICATION. I UNDERSTAND THE MEDICAL AUTHORIZATION FORM MUST BE COMPLETED AND SIGNED PRIOR TO ADMINISTERING. I UNDERSTAND I MUST CLEARLY COMMUNICATE ANY MEDICATION ADMINISTRATION INSTRUCTIONS AND PERMISSION TO OWH STAFF PRIOR TO CAMP. ONE WITH HEART HAS THE RIGHT TO CANCEL CLASSES DUE TO INCLEMENT WEATHER FOR THE SAFETY OF ONE WITH HEARTS MEMBERS. REFUNDS WILL BE GIVEN FOR WORKSHOPS UNDER POLICIES GUIDELINES* (SEE OUR POLICIES PAGE FOR MORE INFO) BUT NO PRORATES FOR ON-GOING CLASSES. I UNDERSTAND VAN OR PUBLIC TRANSPORTATION MAY BE USED. MY CHILD MAY BE PHOTOGRAPHED FOR WITHOUT ANY PERSONAL IDENTIFIERS IN MARKETING MATERIALS AND MEDIA PROMOTING THE SCHOOL. Child's Physician * If signing up more than 1 child, please put other child’s info in also. Physician's Address Physician's Phone * Allergy Information * Date of last Tetanus * Preferred Hospital Health Insurance Company and Phone * Parent or Guardian Signature* * How did you hear about us? * Google Neighborhood Friend Social Media Current Member Other If you said "other," please explain: If you were referred, who can we thank? Thank you! Please scroll down to Step 2 to add camps to your cart.
