The Steward School - Richmond, VA

Academic Form
This additional form is required for all non-Steward students registering for academic camps.

To participate in any Steward Summer Experience camp or class, we must have on file a completed registration and medical form for each camper.

Child Information:

Please complete ONE FORM PER CHILD.

Is your child a Steward Student?

Yes No

Child's Full Name:

Preferred Name:

Address:

City and Zip:

Rising Grade:

Date of Birth:

Sex:

M F

Home Phone:

Alternate Phone:

T-shirt Size:

Child: S M L
Adult: S M L XL

Camp Selections:

Sports Camps - Many New this Year!
	Baseball: Session 1 ($185)	June 9 - 13
	Baseball: Session 2 ($185) This session is FULL!	July 21 - 25
	Cheering ($185)	July 14-18
	Tennis and Volleyball ($200)	June 9 - 13
	Basketball ($185)	June 16 - 20
	Lacrosse and Softball ($185)	June 16 - 20
	Football: Session 1 ($185)	June 23 - 27
	Football: Session 2 ($185)	July 14 - 18
	Soccer ($185)	July 7 - 11

Kindergarten Camps
	Rock, Scissors, Paper! ($475) No longer available.	July 7 - 24
	Kindergarten Play Camp ($200)	July 28 - August 1

Academic Camps If your child is not a Steward Student, an Academic Registration Form is required to complete registration for Academic Camps. When you complete this registration form, please use the link on the left navigation to complete the academic registration form.
	Mission Organization ($250) No longer available.	July 7 - 11
	Science Explosion ($200) No longer available.	June 16 - 20
	Wonderful Words ($425) This session is FULL!	July 21 - August 1
	Step Up To Success ($425)	July 21 - August 1
	Keyboarding ($225)	July 14 - 18
	Head Start on Middle School Session 1: 9 a.m. - 12 p.m.($150) This session is FULL!	July 29 - 31
	Head Start on Middle School Session 1A: 1 - 4p.m. ($150) NEW Session Added!	July 29 - 31
	Head Start on Middle School Session 2A: 9 a.m. - 12 p.m. ($150) This session is FULL!	August 12 - 14
	Head Start on Middle School Session 2B: 1 p.m. - 4 p.m. ($150) This session is FULL!	August 12 - 14
	Language Arts for Middle Schoolers ($375)	July 21 - 25

Dance (This camp no longer available)
	Session 1: 2 weeks, 9a.m. - 12 p.m. ($300)	June 16 - 27
	Session 2: 2-weeks, 1 p.m. - 4 p.m. ($300)	June 16 - 27

Summer Writing Institutes
	Creative Writing ($375) No longer available.	June 23 - 27
	Formula Writing ($375)	July 7 - 11

SAT Prep Class (This camp no longer available) Save $100 when you register for both classes: $250/class or $400/both.
	Math Session (9 a.m. - 12 p.m.) ($250)*	July 28 - August 1
	English Session(9 a.m. - 12 p.m.) ($250) Just added!	July 28 - August 1
	English Session (1 p.m. - 4 p.m.) ($250)*
	*BOTH Sessions ($400)

Young Rembrants *To register for Young Rembrandts camps, please call 804-423-7764.*
*	Animal Drawing ($125 plus $15 materials fee)	June 16 - 20
*	Superhero Cartoon Camp ($125 plus $15 materials fee)	July 7 - 11
*	Pastel Drawing Camp ($150 plus $25 materials fee)	July 14 - 18
*	Pirate Adventures Drawing Camp ($125 plus $15 materials fee)	July 21 - 25
*	Under Sea Adventures ($125 plus $15 materials fee)	August 4 - 8

USA CHESS
To register, please visit the USA Chess Camp website at www.chesscamp.com
or call 1-888-65-CHESS

Parent/Guardian Information

Name of Father/Male Guardian:

Home Address (if different):

City, State, and Zip (if different):

Home Phone (if different):

Cell Phone:

Employer:

Business Phone:

Name of Mother/Female Guardian:

Home Address (if different):

City, State and Zip (if different):

Home Phone (if different):

Cell Phone:

Employer:

Business Phone:

Person(s) or Agency having Legal Custody of Child (if other than parent):

Name:

Home Address:

Home Phone:

Cell Phone:

Business Address:

Business Phone:

Emergency Information

To assist the Summer Experience staff, please list and explain any chronic physical problems, pertinent developmental information, and/or special accommodations needed:

Food/medical allergies or intolerances (and action to take in an emergency):

Important information for parents: Please note that our camps are not allergy-free. We serve snacks with peanuts, wheat, dairy, and other allergens. Please make us aware of any allergies your child has. You may be asked to provide your child’s daily snacks.

Child's Physician:

Physician's Phone:

Insurance Company:

Insurance ID #:

Names, Addresses, and Phone Number(s) of TWO people to contact if parents cannot be reached:

#1 Emergency Contact:

Name :

Street Address:

City, State and Zip:

Home Phone:

Work Phone:

Cell Phone:

#2 Emergency Contact:

Name:

Street Address:

City, State and Zip

Home Phone:

Work Phone:

Cell Phone:

Persons other than parents/guardians who are authorized to pick up child:

Person(s) NOT Authorized to Pick Up Child*:

* Appropriate paperwork such as custody papers should be sent if a parent is not allowed to pick up the child.

The Summer Experience Agreement
(must be signed to complete registration)

The School agrees to notify the parent/guardian whenever the child becomes ill and the parent/guardian will arrange to have the child picked up as soon as possible if so requested.
The parent/guardian authorizes the School to obtain immediate medical care if any emergency occurs when he or she cannot be located immediately. (If there is an objection to seeking emergency care, a statement should be provided by the parents/guardians that states their objection and the reason for objection.)

Signature:

Date:

Confirmations and updates on your child's registration for The Summer Experience will be sent via e-mail. Email Address:

PLEASE READ BEFORE CLICKING BELOW:
This form DOES NOT calculate your total costs. Please manually calculate the total cost of your camp selections and submit this amount on the following payment screen. Your registration will not be completed until your payment has been submitted via credit card on the next screen.

11600 Gayton Road Richmond, Virginia 23238 phone: 804.740.3394 site credits