Clone of 2025 Agawam InspireWorks Summer Enrichment Camp Registration

Child #1 Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Grade in Fall (Upcoming Year)*

1st2nd3rd4th5th6th7th
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Allergies and/or Restrictions (if none please write "None")*
Has this child attended InspireWorks Summer Camp before?*

What Sessions are you registering for?*

Rows	Camp Day 9AM-3:30PM	Pre Camp 7:30AM-9:00AM	Post Camp 3:30PM-5:30PM
Session 1: June 29-July 2 No Camp July 3rd
Session 2: July 6-July 10
Session 3: July 13-July 17
Session 4: July 20-July 24
Session 5: July 27-July 31
Session 6: August 3-August 7
Session 7: August 10-August 14
Full Summer Special: Buy 6 Weeks Get a 7th Free June 29-August 14

*The Full Summer Special applies to the Camp Day only (Pre & Post Camp are excluded). Cannot be combined with other discounts or offers. The special pricing applies to registrations received by May 1st.
ALERT: It seems there may be an error with your camp week selections. Please verify that you have not registered for both the Full Summer option and any individual camp weeks.
Would you like to pre-order a camp t-shirt?*
Please select your t-shirt size ($16/shirt)*

Youth MediumYouth LargeYouth Extra LargeAdult SmallAdult MediumAdult LargeAdult Extra Large
Child #1 Total
Would you like to add another child?*
Child #2 Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Grade in Fall (Upcoming Year)*

1st2nd3rd4th5th6th7th
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Allergies and/or Restrictions (if none please write "None")*
Has this child attended InspireWorks Summer Camp before?*

*The Full Summer Special applies to the Camp Day only (Pre & Post Camp are excluded). Cannot be combined with other discounts or offers. The special pricing applies to registrations received by May 1st.
ALERT: It seems there may be an error with your camp week selections. Please verify that you have not registered for both the Full Summer option and any individual camp weeks.
Would you like to pre-order a camp t-shirt?*
Please select your t-shirt size ($16/shirt)*

Youth MediumYouth LargeYouth Extra LargeAdult SmallAdult MediumAdult LargeAdult Extra Large
Child #2 Total
Would you like to add another child?*
Child #3 Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Grade in Fall (Upcoming Year)*

1st2nd3rd4th5th6th7th
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Allergies and/or Restrictions (if none please write "None")*
Has this child attended InspireWorks Summer Camp before?*

*The Full Summer Special applies to the Camp Day only (Pre & Post Camp are excluded). Cannot be combined with other discounts or offers. The special pricing applies to registrations received by May 1st.
ALERT: It seems there may be an error with your camp week selections. Please verify that you have not registered for both the Full Summer option and any individual camp weeks.
Would you like to pre-order a camp t-shirt?*
Please select your t-shirt size ($16/shirt)*

Youth MediumYouth LargeYouth Extra LargeAdult SmallAdult MediumAdult LargeAdult Extra Large
Child #3 Total
Grand Total

Parent/Guardian Information

Parents/Guardians entered below will automatically be listed as emergency contacts and authorized pick-ups. Any person picking up a camper (including parents) will be required to show a photo I.D. prior to each pick up.
Parent/Guardian #1 Name*

First NameLast Name
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
example@example.com
If you use Comcast as your email provider, we cannot guarantee that you will receive the camp confirmation email due to Comcast restrictions beyond our control. We encourage you to register with an alternate email address to ensure you receive all camp communications.
Is there a current restraining order regarding who may have contact with the child(ren) you are registering today?*
Is there a court order in regards to custody of the child(ren) you are registering today?*
If you answered YES to either of the two questions above, you must inform the Camp Director in writing and provide a copy of the court order and/or custody agreement for the child(ren)’s file.
Would you like to add another Authorized Parent/Guardian?*
Parent/Guardian #2 Name*

First NameLast Name
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
example@example.com
Authorized Pickups/Emergency Contact

In addition to the Parent/Guardian(s) listed above your child(ren) will not be released to any person other than those indicated on the sheet below. Any person picking up a camper will be required to show a photo I.D. prior to each pick up. In case of an emergency/illness where we can not get in touch with parents/guardians, we will call the following contacts in the order listed.
Authorized Pickup #1*

First NameLast Name
Relationship*
Daytime Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Would you like to add another Authorized Pickup/Emergency Contact?*
Authorized Pickup #2*

First NameLast Name
Relationship*
Daytime Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Would you like to add another Authorized Pickup/Emergency Contact?*
Authorized Pickup #3*

First NameLast Name
Relationship*
Daytime Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Would you like to add another Authorized Pickup/Emergency Contact?*
Authorized Pickup #4*

First NameLast Name
Relationship*
Daytime Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number

Policy Acknowledgement and Waivers
Your Name*

First NameLast Name
Signature*

By signing I attest that I am the legal guardian of the child(ren) registered, I have read this form carefully and have had all questions answered before signing this legal document and to the best of my knowledge all of the information stated herein this document is true and accurate. By signing I understand I will be bound by my agreement to the terms in this document.

Payment Info
Child 1 Subtotal:
Child 2 Subtotal:
Child 3 Subtotal:
Which payment method would you prefer?*
Enter Your Personalized Invite-Only Code*
Payment Plan Details:

To participate in the payment plan a 25% non-refundable deposit must be made to InspireWorks Enrichment through the Melio digital payment platform. Once the initial deposit has been made, the remaining balance can be made in lump sum or installments, whichever is most convenient for you.

Please be aware of the following:

1.    A space will not be reserved for your camper(s) until a non-refundable 25% deposit has been received through the Melio payment link provided in your confirmation e-mail.

2.     Payments must be made via ACH (bank transfer) or credit/debit card through Melio. ACH transfers are free, while Melio applies a processing fee to credit/debit card payments.

3.    The final payment deadline is May 30th. Overdue accounts after May 30th will be subject to a late fee of $30 per child and/or may result in cancellation of your child’s camp registration. In the event your registration is canceled by InspireWorks Enrichment due to non-payment, you will be refunded any payments made, minus the non-refundable 25% deposit.

4.    Refunds: Refund requests (minus the initial 25% deposit) will be honored up to May 30th after which no refunds will be permitted.
Please only select this option if you are an approved participant in the Child Care Voucher program through the local CCR&R and receive financial assistance through their organization.

In order to transition your provider to InspireWorks Enrichment for the summer, you will need to provide your caseworker with a Confirmation of Provider form. Please see your confirmation e-mail for details on this as well as the parent fee schedule.
ALERT:

InspireWorks Enrichment accepts a limited number of campers using vouchers as payment. Due to high demand, registration is by invitation only.

Campers wishing to use a voucher must first sign up on our WAITLIST. If/when a space becomes available for your camper, we will contact you with a unique registration code to use in this online registration portal.
Total amount Due
25% Deposit
Total Due

prevnext( X )
USDDescription
Child 1 Week Test
Child 2 Week Test
Child 3 Week Test

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Child #1 Information

Child #2 Information

Child #3 Information

Parent/Guardian Information

Authorized Pickups/Emergency Contact

Policy Acknowledgement and Waivers

Payment Info