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Elementary Summer Camp 2024 on Sunday, June 9, 2024 @ 1:30 PM

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10.00 
IMPORTANT INFO!

Make sure you put the child attending summer camp in the Attendee's First and Last Name section above.

However, provide the Parent/Guardian's email and phone number in the Attendee Email and Phone Number areas above.

If you plan on only paying the deposit for registration, make sure you select the $100 (deposit) in the drop down box next to price at the top of the page and not $505. 

We are now requiring the full payment for camp to be completed before a child leaves for camp on June 9th. If you need financial assistance, email Will Pearce at wpearce@wacc.net or Jenna Zeronis at Jennaz@wacc.net

Additionally, make sure you are logged into the account of whoever is PAYING on my.wacc.net/portal and not the child's or another person's. If you do not do so, your payments and balances may not show up in your purchase history, which you may need to find later for further payments or to keep a record of your purchases.

Lastly, so you know, your child will neither be registered, nor will the information you have filled out here on this page be saved, until you have paid the camp deposit or the full balance. Payment will occur on the next page once you have finished filling out the rest of the information and have clicked Next. If you have any trouble paying the deposit, contact Will Pearce at (562) 945-4500 ext. 186 or at wpearce@wacc.net or Jenna Zeronis at (562) 945-4500 ext. 179 or at  Jennaz@wacc.net. 
*Child's First Name:
*Child's Last Name:
*Grade heading into Fall 2024:
*Date of Birth:
*Will you need a scholarship for camp?:
*Parent/Guardian First Name:
*Parent/Guardian Last Name:
*Parent/Guardian Phone Number:
*Parent/Guardian Email:
*Emergency Contact Name:
*Emergency Contact Number:
*Insurance Provider:
*Subscriber/Member #:
*Name of Policy Holder:
*List any medical and/or allergy alerts for child:
*List any dietary restrictions your child may have:
List roommate(s) preference:
Parent or Guardian Consent and Liability Release June 9th, 2024 to June 14th, 2024:
I, the undersigned parent or legal guardian of the above mentioned minor, do hereby authorize any leaders from Whittier Area Community Church (hereinafter WACC) to authorize and consent any examination, anesthetic, medical or surgical diagnosis rendered under the general or specific supervision of any member of the medical or emergency room staff licensed under the provisions of the Medicine Practice Act, or a dentist licensed under the provisions of the Dental Practices Act and on the staff of any acute general hospital or emergency facility holding a current license from the Dept. of Health. It is understood and agreed that WACC’s insurance is only secondary insurance and that the signer’s medical insurance will be billed for any and all medical charges in the case of illness or injury resulting from participation in any way with an activity sponsored by WACC. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required and is given to provide authority and power to render care and/or treatment to the patient regardless if the undersigned is able to be contacted. Further, the undersigned agrees that WACC, its volunteers, employees, and affiliates shall be held harmless from any and all liability for damages to person or property to the participant’s above mentioned that may arise out of, en route to and from, in residence, or as a result of, any involvement or participation in activities sponsored by WACC. In exchange for the privilege of participation in activities sponsored by WACC, I hereby indemnify and hold harmless WACC, the staff, employees, and volunteers of WACC from any and all liability and expenses incurred as a result of participation. 
The health information on this form will only be shared, as needed, with group leaders and medical professionals to safeguard and support the child in an emergency situation. This information will not be publicly disseminated or released to any outside organization.
*I agree to the above Consent and Liability Release:
Photo Release: I will allow my child's photograph to be published on the WACC website and/or to be used by WACC for promotional and social media purposes.  Photographs may be published in the form of print, electronic, video or photographic materials created for church use.
*I agree to the above Photo Release:
*Electronic Signature:
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