Application for Summer Program at American Legion
Each week campers will get to explore the different themes through movement, exploration and play. Most of all of our activities will be outdoors (in primarily shaded areas), please make sure that your camper is dressed and ready for outdoor fun and has their sunscreen on! Each week campers will bring home all the crafts that they have created. This year we will be sharing the American Legion Property with PI Summer. Please note that these are 2 separate camps and enroll seperatly. That said, we will include some of their campers in some of our projects as well as get to be involved in some of their activities from time to time (such as a bouncy cancel and special guests). During These Activities there will also be an Amanda Kupillas Staff member with our campers.

*Campers must be entering Kindergarten – 2nd grade. (with the exception of week 1. Which is geared towards kids entering 3rd-5th). Please be sure to pack a snack, but please make sure it is nut free and have kids ready with sunscreen!
Camp starts 9:00 at the back entrance of the American Legion. Pick up is at same location at 12:00.

Amanda Kupillas Summer at American Legion
Name of Student *
Name of Parents/Guardian 1 and Phone: *
Name of Parents/Guardian 2 and Phone:
Email *
Address: *
Grade child is entering in the Fall of 2022: *
Which Week are you interested in attending: *
Required
Does your child have allergies. *
If Yes, Please list allergies. NOTE: We cannot be responsible for administering an Epipen. :
We will be making food in week 2 that we will not eat, but will be brought home. It will have herbs, pumpkin seeds, cheese, oil, lemon and salt. Can your kid participate?
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Please let us know if there is anything you would like to let us know about your child before camp starts.
I give permission for my child/children to participate in the following activities:  Yoga, Dancing, Crafts, and any other Day Camp related activities. I give permission for my child/children to participate in some activities with PI (Project Inclusion) Summer Program.   On behalf of myself and/or my child/children’s participation in the above activities, I do hereby waive, release and discharge any and all claims for damages of any nature as a result of injury, which may occur to my child as a result of my and/or my child’s participation in the above activities. I further agree to indemnify and hold harmless Amanda Kupillas Dance from any liability to myself, my child or any third party arising or in any way connected with my and/or my child’s participation in the above events.  I have also read Amanda Kupillas Policy Page. *
By checking below, I also give Amanda Kupillas Dance permission to use photographs or videos of the named participant in its promotional/educational materials. *
Checks should be made out to Amanda Kupillas Dance. Mailing Address: 12 Maple Lane, Hastings-on-Hudson, NY 10706 OR Venmo @Amanda-Kupillas-1. No refunds will be given past June 17th. *
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