2026 Summer Camp Detailed Registration Form

Student's Name*

First NameLast Name

Birth Date*

MonthDayYear

Grade Completed in 2026*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent/Guardian#1*

First NameLast Name

Cell Number*

E-mail*

example@example.com

Parent/Guardian #2 (if applicable)

First NameLast Name

Cell Number

Please enter a valid phone number.

Email

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Tell us about your student. What are their interests and/or greatest strengths?*

Does your student need any accommodations? If, so, how can we help facilitate successful learning this summer.

Informed Consent and Acknowledgement

I hereby give my approval for my student's participation in any and all activities prepared by Wyoming Valley School Inc. during the selected art program. In exchange for the acceptance of said student's candidacy by Wyoming Valley School Inc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Wyoming Valley School Inc. and all its respective officers, agents, and representatives from any and all liability for injuries to said student arising out of participating in from selected art program sessions.

In case of injury to said student, I hereby waive all claims against Wyoming Valley School Inc., including all teachers and affiliates, and all participants. There is a risk of being injured that is inherent in all physical activities.

Photography & Videography

Wyoming Valley School Inc., and its agents, have the irrevocable and unrestricted right to produce photographs and video taken of my student while at Wyoming Valley School for any lawful purpose, including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release Wyoming Valley School Inc., and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.

I give permission for my student to be photographed.I do not give permission for my student to be photographed.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

Registration Fee & Payment - The registration fee is due at the time of registration. BUT YOU ARE NOT REQUIRED TO PAY IN FULL AT REGISTRATION. SELECT REGISTRATION FEE AND SESSIONS YOU CHILD WILL BE ATTENDING, BUT USE PROMO CODE CHECK IF YOU WOULD LIKE TO PAY BY CHECK AT A LATER DATE. All payments are due by May 1, 2026. If paying by check, use promo code: CHECK. *

Non Refundable Registration Fee

Please pay one registration fee PER FAMILY. Not per student. The registration fee is due at the time of registration.

$30.00

Summer Unleashed | June 15-26 | Lead Teacher: Jennifer Moore-Kerr

Kick off summer by exploring the beautiful Wyoming Valley School and its grounds, embracing the nature around us, and diving into active, imaginative play. We’ll explore art in many forms, including creating nature prints, making recycled paper, and nature journaling, all while building a kind and supportive community.

$550.00

Nature & Movement: Get Moving | July 6- July 17 | Lead Teacher: Isabel Radtke

We’ll jump into creativity through movement and imagination in this session that’s all about self-expression and uncovering art in the world around us. We’ll try different musical rhythms, dive into outdoor adventures, and discover that performance is all about making it your own. With storytelling, dancing, sound-making, and imaginative prompts, we’ll build confidence while having a blast!

$550.00 Quantity

Dream, Design, Do! | July 20-31 | Lead Teacher: Jennifer Moore-Kerr

This session is inspired by Frank Lloyd Wright, the master architect who designed our inspiring space. We’ll dive deep into designing and building using a myriad of found and commercial materials–think empty boxes, tubes, and legos. We’ll also discuss — and put into practice — what it means to build a strong, caring community.

$550.00 Quantity

Fun is in our Nature: Fiber, Bead & Clay | August 3-14 | Isabel Radtke

This session is all about nature-rooted artmaking. We’ll try fiber arts such as weaving, felting, and sewing using traditional materials and items gathered from nature. We’ll make dyes from flowers, leaves, and berries, creating art directly from the Wyoming Valley. In beading and ceramics projects, we focus on fine-motor skills, design, and the joy of building something (literally) from the ground up!

$550.00 Quantity

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Total

$0.00

Payment Methods

Credit Card

ACH Bank Transfer

2026

Student Information

Payment Methods