Summer Camp 2015Registration Form

Mail: C/O Education Dept.
20850 Oatlands Plantation Lane
Leesburg, Virginia 20175

Child isattending: __ Archaeology Field Camp: June 22-26 __ Time Travelers: July 20-24
__ Arts & Crafts: June 29-July 3 __ Drama Camp week 1: July 27-July 31
__ Closed Terrarium Camp: July 6 Drama Camp week 2: August3-7
__ Tillandsia (air plant) Camp: July 7 Drama Camp week 3: August 10-14

Student’s Full Name: ______Gender: M F (circle)

Street Address: ______

______

Grade Level for 2015-2016 School Year: ______Age: ______

Archaeology camp is open to rising 3rd-7th graders. Arts & Crafts and Time Travelers camps are open to rising 4th-6th graders. Drama camp is open to rising 6th -9th graders.Terrarium and Tillandsia camps are open to rising 3rd – 6th graders

Parent’s Name(s) (please print): ______

Home Phone: ______

Mother’s E-mail: ______Father’s E-mail: ______

Mother’s Cell Phone: ______Father’s Cell Phone: ______

Mother’s Work Phone: ______Father’s Work Phone: ______

Important: Please note Child’s Allergies or Special Medical Conditions:______

Emergency Contact:

Rules and Regulations for Oatlands Summer Camps:

  • Please try to arrive on time. If you will be delayed, please call as soon as possible. 703-777-3174 ext. 103.
  • Campers will be expected to display appropriate behavior. Failure to do so will result in removal from the program.
  • Campers need to bring a lunch and snacks with them. Water will be provided.
  • Campers need to bring sunscreen and insect repellant
  • Campers should wear comfortable clothes and shoes. Open toe shoes and sandals are not advised.
  • No food, gum or drinks are permitted inside the house.
  • Parents are expected to pick students up promptly at the end of the session.

We have read and understand the rules and regulations.

Parent’s Signature: ______Date: ______

Cancellation policy: Payments are fully refundable until30 days prior to the start date of camp. After this date, payment is not refundable except in case of illness or emergencies.

Fees: Archaeology Camp: $200/child Arts & Crafts: $120/child (includes supplies)

Closed Terrarium Camp: $65/child Tillandsia Camp: $55/child

Note: Drama Camp Registration $600/childis paidthrough StageCoach Theatre Company

Please choose payment option below:

Check Number: ______Amount Paid: ______Please make checks payable to Oatlands.

Credit Card: Visa or MasterCard only (circle one) Number ______CVV# ______

Name on card: ______Expiration Date: ______Amount: ______

Release Form

Camp and program participants might be photographed, videotaped, and audiotaped as part of their activities while at Oatlands. Photographs, videos, or audio may be used to provide information to the public about Oatlands’ educational programs and activities. This information might be in the form of publications, displays, newspaper ads or stories, web site content, and social media, including but not limited to, Facebook and blogs.

Camp and program participants might use Oatlands’ social media to post comments about their activities, what they learned, etc. Social media may include, but not be limited to, Facebook, Twitter, and/or blogs.

Camp and program participants might use their name in social media or when video/audiotaping. For example, Arts & Crafts campers will exhibit their work to family members and other visitors; a camper might welcome guests by saying hello and stating his/her name.

Since your child’s participation in media produced by Oatlands is voluntary, there will be no financial compensation.

It is important that we receive permission from parents or guardians to have their child photographed, videotaped, or audiotaped for use in media, to use the child’s name, and to allow their child to participate in Oatlands’ social media.

I grant permission for my child to be photographed or featured in any videotape, television, audio recording, or broadcast that will be produced by and available to the public from Oatlands, or to the media. I grant permission for my child to use Oatlands’ social media. I authorize Oatlands to use the photographs or videos of my child and to use the child’s name.

Child’s Name: ______

Parent’s Name: (please print)______

Parent’s Signature: ______Date: ______