Which week of camp are you registering for?

Week 2: July 10-14 – Pottery Camp

Week 3: July 17-21 – Pottery Camp

Child’s First Name

Child’s Last Name

Child’s Birthday

Child’s Age (as of the date of camp)

Does your child have life threatening allergies?

Yes

What is your child allergic to?

Will your child have an EpiPen/Auvi-Q with them?

Yes

Medical Information

Additional Information

Parent/Guardian’s First Name

Parent/Guardian’s Last Name

Parent/Guardian’s Phone

Parent/Guardian’s Email

Additional Emergency Contact – First Name

Additional Emergency Contact – Last Name

Emergency Contact’s Phone

Relationship to Child

Photo Policy: Our students are our best ambassadors and we often photograph and/or video students during the program for promotional purposes.

I give my permission for Stepping Stones Pottery to photograph and/or video for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Please sign below:

Sign Here

Responsibility of Parent/Guardian Policy

The following policy reflects our concern for your child’s physical welfare. Please read carefully. We cannot admit your child without your consent to this waiver.

Stepping Stones Pottery is NOT responsible for children/students before or after the hours for which they are registered for class. Parents and children are welcome to enter Stepping Stones Pottery at the program’s stated start time. Tuition however, only covers teaching time and does not include supervision before or after class hours.

Stepping Stones Pottery reserves the right to require parents or guardians to withdraw a child from class for disruptive behavior at any time.

I have read and understand the Responsibility of Parent/Guardian Policy.

Please Sign Below:

Sign Here

Parent/Guardian Waiver and Medical Release

As parent/guardian, you individually and on behalf of your child, release and agree to hold Stepping Stones Pottery harmless from any and all liability and hereby assume all risk and responsibility and waive any claim or cause of action of any nature whatsoever arising on behalf of your child while at Stepping Stones Pottery or otherwise in the care of its staff. You further agree to indemnify and hold harmless Stepping Stones Pottery, its agents, employees or contractors, whether paid or volunteer, against any and all claims which may arise from any injury to said child while participating in this program. You have read and understand the above policy and agree to comply with its provisions.

In the case of an emergency involving your child, you hereby authorize Stepping Stones Pottery staff to call 911 to provide urgent care for your child. Every effort will be made to contact you. In the event that you cannot be reached to make arrangements for emergency medical attention at the time of illness or accident, you further authorize your child to receive medical treatment from the Stepping Stones Pottery selected medical provider as such medical provider deems necessary and appropriate.

I have read and understand the Parent/Guardian Waiver and Medical Release.

Please sign below:

Sign Here

Camp Tuition of $275 is due in full to secure your child’s registration, as spots are very limited.

After you click “SUBMIT FORM” you will be redirected to PayPal to complete the transaction. Debit and credit cards are accepted; no PayPal account is needed.

Pottery Camp Tuition

Price: $275.00

Coupon Code (if applicable)

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