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Summer Program Registration

Child's First name*

Last name*

Date of Birth*

Month

Day

Year

Age (7 to 15 only)*

Gender*

Male

Female

T-Shirt Size*

Youth-S

Youth-M

Youth-L

Adult-S

Adult-M

Adult-L

Parent/Guardian Information

First Name*

Last Name*

Relationship to camper?*

Phone*

Primary Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Second Parent/Guardian Information (not required)

First Name

Last Name

Email

Phone

Relationship to camper?

Authorized to Pick-Up?

Yes

No

Medical Information

Does your child have any food, medication, or environmental allergies? (if so please list them below)*

Does your child have any medical conditions/limitations (if so please list them below)*

Does your child have any special needs? (if so please list them below)*

Will your child need to take any medications during camp? (if so please list them below)

Primary Doctors Name

Primary Doctors Phone Number

Insurance Provider & Policy Number

Pick-Up Authorization (additional)

First & Last Name (must provide ID)

First & Last Name (must provide ID)

Camp Preference

This program is designed to help campers explore their creative side and learn how to develop those skills in an exciting and profitable way.

Which of these do you think your child would be most interested in? (choose all that apply)*

Sewing/Fashion Design

3D Printing

T-Shirt Design & Print

Laser Engraving

Cups & Mugs Design

Jewelry Making

Is there anything else you would like us to know about your child?

Are you registering more than one child? (If so, please list their names and ages below.)

Photo/Video Release Consent

I give permission for my child to be photographed or recorded during camp activities. I understand that these images may be used for promotional or educational purposes by the W.A.Y. Center, including on social media, websites, and printed materials.

Single choice*

Yes, I give permission

No, I do not give permission

Parent/Guardian Consent & Agreement

I, the undersigned, give permission for my child to attend the Skills & Development Camp hosted by the W.A.Y. Center. I understand that camp activities include physical movement, outdoor and indoor play, and use of equipment that include extreme heat, needles and other sharp objects, lasers, small pieces, glass, ceramic, and other materials that could cause harm of any kind, and although the instructors and the company will practice and teach safety at all times, my child is participating at their own risk. I authorize emergency medical treatment if necessary. I agree to follow all policies provided to me.

By typing your full name below, you acknowledge and agree that it serves as your legal signature and carries the same authority as a handwritten signature.

Signature*

Date*

Payment

We offer payment options for this program. The payment options are listed below:

Full payment: $800
Weekly payments: $100
Bi-weekly payments: $200

*Family Discount: Families will receive a 10% discount for every additional child registered. This discount does not apply to the first child.

You will receive a welcome email with further instructions that will allow you to submit your payment option. This must be completed within 48 hours to keep your child's spot in the program.

The W.A.Y. Center

Women & Youth Creative Arts & Skill's Development Center

Get in touch with us! We’re here to assist you with any questions or feedback you may have. Please feel free reach out or stop by.

Email: contact@thewaycenter.org

Address: 1821 W. Lancaster Blvd.

Lancaster, Ca 93534

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