MC After 3 Summer Camp

MC After 3 Summer Camp Application
What’s Missing this S_MMER? YOU Are!!!

It’s time to register for our 8th annual MC After 3 Summer Camp to be held at Cacapon State Park for 2 weeks: July 25 – August 5, 2022. Camp is for MORGAN COUNTY STUDENTS entering grades 6-12 for school year 2022-23 and it is FREE! Breakfast, lunch and a snack are provided. Space is limited! You may attend EITHER or BOTH weeks. Please indicate your choice on the registration form. You will be contacted individually after the JULY 17th deadline to complete the registration process. Hope to see you there for some fabulous FUN IN THE SUN!

*Limited bus transportation is provided. More information will be given when you are called to complete the registration process.

Please direct questions to Summer Goller, call/text 304-702-9841 or email summer.goller@k12.wv.us.com.
Student's Name *

First Name Last Name
2022-2023 Grade Level *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Which week(s) of camp will the student be attending? *

Both weeks July 25-29 August 1-5
Sex *

Male Female
Birthdate *

Month Day Year
Date
T-Shirt Size: Child/Adult *
2022-2023 School *
Custodial Parent/Guardian *

First Name Last Name
Day Phone *
Please enter a valid phone number.
Cell Phone *
Please enter a valid phone number.
Email *
example@example.com
Second Parent/Guardian

First Name Last Name
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Day Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Persons to contact in case of emergency if parent/guardian can't be reached:
Name *

First Name Last Name
Phone *
Please enter a valid phone number.
Name

First Name Last Name
Phone
Please enter a valid phone number.
The following individuals have permission to pick up my child from summer camp.
Name

First Name Last Name
Relationship to Student
Phone
Please enter a valid phone number.
Name

First Name Last Name
Relationship to Student
Phone
Please enter a valid phone number.
During MC After 3 Summer Camp, photographs or tapes may bemade of children in the program which could be used in the newspaper, on ourwebsite, or in publicity about the program. Your signature givespermission to use photographs or tapes of your child. Your answer doesnot affect your child’s participation in MC After 3 Summer Camp. Check the oneswe may use:

Photographs Audio Video
Parent/Guardian Signature

Clear
Should be Empty:

MC After 3 Summer Camp Application

Persons to contact in case of emergency if parent/guardian can't be reached:

The following individuals have permission to pick up my child from summer camp.