The COMM

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2021 Comm Camp Registration Form

Choose Your Week(s)

Please only register one camper on this form

Regular Camp - 9am to 1pm - $120.00

Extended Camp - 1pm to 3pm - $50.00

Please enter your child's grade level:

Level 1 - Week 1 is currently closed. Please contact the Comm office at 570-586-8191 if you would like to put be on the waitlist.

Level 1: 4 yrs old

Level 2: entering Grades 1 or 2

Level 3: entering Grades 3 or 4

Level 4: entering Grades 5, 6 or 7

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Week 1 - June 21 thru 25 - "Super Hero Week"

Regular Camp - Week 1

$120

Extended Camp - Week 1

$50

Week 2 - June 28 thru July 2 - "Witches & Wizards Week"

Regular Camp - Week 2

$120

Extended Camp - Week 2

$50

Week 3 - July 5 thru July 9 - "Comm Camp Olympics"

Regular Camp - Week 3

$120

Extended Camp - Week 3

$50

Week 4 - July 12 thru July 16 - "Beach Ball Barbeque Week"

Regular Camp - Week 4

$120

Extended Camp - Week 4

$50

Week 5 - July 19 thru July 23 - "Movie Character Week"

Regular Camp - Week 5

$120

Extended Camp - Week 5

$50

Week 6 - July 26 thru July 30 - "Christmas in July" (Level 4 will attend Hillside Park)

Regular Camp - Week 6

$120

Extended Camp - Week 6

$50

Week 7 - August 2 thru August 6 - "Encore" (Level 4 will attend Hillside Park)

Regular Camp - Week 7

$120

Extended Camp - Week 7

$50

The total registration amount will automatically calculate below

Camper Information

Camper's Name:

Grade child will enter 9/2021:

Child's Age:

Date of BIrth:

Parent/Guardian Names:

Address:

Email:

Phone # to reach you during Camp hours:

Emergency Contact:

Emergency Contact Phone #:

Release: I/we do not, will not hold any individual associated with "Comm Camp, Waverly Community House Employees, Board of Trustees, volunteers or Waverly Twp responsible for any accident or injury incurred by my child while participating in this Camp.

Medical - ** Proof of up-to-date immunizations required

Please check where applicable:

My camper has permission to be transported by ambulance in case of emergency

Hospital Preferred

Camp staff have permission to administer emergency First Aid as needed to my camper

Name of camper's pediatrician or family doctor

My camper has the following known allergies

My camper has other medical conditions that I will need to bring to staff attention

My camper's immunizations are up to date

Camp staff have permission to administer the following medications to my camper

Tylenol

Benedryl

Other (please name)

Field Trips

My camper has permission to be transported by school bus to camp field trips

My camper DOES have permission to swim at the Lackawanna State Park pool during field trips

My camper DOES NOT have permission to swim at the Lackawanna State Park pool during field trips

Photo Release

My camper may be photographed by The Comm while at camp for use in connection with The Comm.

My camper may NOT be photographed by The Comm while at camp

Payment Contact Information

First Name

Last Name

Mobile Number

Address

City

State

Zip

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV What is this?

I would like to cover the payment processing fee.

Thank you

Thank you for registering for Comm Camp!

Camper Information

Medical - ** Proof of up-to-date immunizations required

Field Trips

Photo Release

Payment Contact Information

Thank you

Consider adding a donation for our Centennial celebration!