Wellness Camp Registration 2024

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Please complete all information thoroughly for your student so we can plan accordingly. Wellness camp will be held June 10-June 14 from 8:30-12:00 daily at Watkins Intermediate School. Drop offs can start by 8:15 each morning in the front of the building and pick ups should happen by 12:00 in the same location as drop off. Snacks will be supplied daily for your student so please include any allergy information/dietary needs in the form below. Students should wear tennis shoes and water bottles are encouraged to be brought daily. Registration for your student will be $100 and that fee includes a t-shirt and the supplies needed for the weekly activities including crafts, games and snacks. Registration needs to be paid within 48 hours through E-Z pay (details will be emailed to you once you register). Registering does not guarantee a spot until payment has been made. Please reach out with questions or concerns to: acarter@laca.org.

Email *

Student First Name: *

Student Last Name: *

Student I.D. Number or Lunch code (6 digits)

Student Grade level next year (2024-2025): *

3rd

4th

5th

6th

School building student currently attends:

Etna Elementary

Kirkersville Elementary

Pataskala Elementary

Watkins Intermediate School

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Student Address *

Primary Contact Phone Number: *

List up to TWO emergency contacts with phone numbers: *

In the event of an emergency, our staff will utilize the emergency contact form that is on file, if this is an issue please call to update your forms with your student's building secretary. If the form is up to date please verify your understanding below: *

My student's ER contact form is up to date and can be utilized in the event of an emergency when it comes to medical, dental or other emergency needs.

I will reach out to my student's school building secretary to make changes that are necessary before sending my student to STEAM camp.

Required

Please list any medical concerns, allergy needs and/or dietary restrictions: (Please note if your student has severe food allergies-you are required to supply them with a snack each day). *

Does your student have any educational needs or specifications we should be aware? If not, please put NA. *

Does your student have any behavioral needs or concerns our staff should be aware of? If not, please put NA. *

My student will be dropped off daily at 8:15 am by: (please list any approved person that may be dropping your student off below) *

My student will be picked up daily at 12:00 PM by: (please list any approved person and contact phone number for those permitted to pick up your student-we will be checking id) *

Student T-shirt size:

Youth XS

Youth S

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

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Registration payment will be submitted within 48 hours through:

I will pay through E-Z pay once I receive my registration and confirmation email. Please note if payment has not been secured within 48 hours your student's registration will not be valid.

I will pay with cash or check by coming into the District Office at 927 A South Street, Pataskala, 43062.

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