Online Camp Registration

1st Child Name

First Name

Last Name

Gender

Date of Birth

YYYY

Age as of 7/1/15

Grade

School

2nd and 3rd Children

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Very Important for Camp updates

2nd Child Name

First Name

Last Name

Gender

Date of Birth

YYYY

Age as of 7/1/15

Grade

School

3rd Child

First Name

Last Name

Gender

Date of Birth

YYYY

Age as of 7/1/15

Grade

School

Mother Name

First Name

Last Name

Parent/Guardian Agreement

I give permission for my child/children, listed above, to participate in the Summer Playground Program sponsored by Wenham Village Improvement Society (WVIS) and to travel by private car or chartered bus as necessary during program activities or in case of an emergency. I agree and hold harmless WVIS, its members, committees, board, officers, agents, and employees from any and all liability for personal injuries of any extent to my child/children or others or damages to persons or property that might result in any way from my child/ children’s participation in this WVIS Summer Playground Program. I hereby authorize necessary medical treatment for my child/children.

Online Camp Registration

Wenham Village Improvement Society

A philanthropic organization. All profits benefit the community, including scholarships, a playground, a summer camp program, and tennis courts.