Workshop & Camp Registration

Student Name *
Student Name
Student's Gender Pronouns *
*PLEASE NOTE* Due to high demand for our Summer Writing Camps and the limited space, we are only able to offer one week of camp per student. Please register for student's first choice camp. You may request to be added to the waitlist for a second week via email.
Student Birthdate *
Student Birthdate
Parent/Guardian 1 Name *
Parent/Guardian 1 Name
Parent/Guardian 1 Address *
Parent/Guardian 1 Address
Is this Student's primary residence? *
Parent/Guardian 1 Phone *
Parent/Guardian 1 Phone
(primary)
Parent/Guardian 1 Phone
Parent/Guardian 1 Phone
(secondary)
Parent/Guardian 2 Name
Parent/Guardian 2 Name
Parent/Guardian 2 Address
Parent/Guardian 2 Address
Is this Student's primary residence?
Parent/Guardian 2 Phone
Parent/Guardian 2 Phone
(primary)
Parent/Guardian 2 Phone
Parent/Guardian 2 Phone
(secondary)
Additional Emergency Contact Name *
Additional Emergency Contact Name
In the event of emergency, Parents/Guardians will be contacted FIRST. Please provide a NON-Parent/Guardian Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Emergency Care Authorization *
In the event of serious accident or injury, every effort will be made to contact a parent or guardian. Because I understand that a situation could arise when first aid and/or emergency treatment may be necessary and I cannot be reached, I hereby authorize Read and Write Kalamazoo personnel to make provisions for treatment with the appropriate medical personnel or facility. I also understand that in the event my student (who is under the age of 18) needs to be taken to an emergency room, they will be taken to Bronson via ambulance (as Borgess does not provide pediatric emergency services).
Typing your name here is a digital signature confirming your response to the above Emergency Care Authorization
Please inform us of any allergies or health concerns (including any and all medications) which may be pertinent to our time with your student. If student will have medication with them (inhalers, EpiPens, etc.), a form must be completed onsite.
Photo Release *
I permit Read and Write Kalamazoo to take photographs of my student for the explicit purpose of chronicling and promoting the RAWK program. I understand that any photographs of my child taken during RAWK programming will not be used by anyone not affiliated with Read and Write Kalamazoo.
RAWK involves working in large and small groups, one-on-one interactions, giving and receiving feedback, reading aloud, and active listening. Please provide us with any special information you feel would help us create a safe and supportive environment for your student.
Reserve My Spot *
There are a limited number of spots available in each workshop. By completing this registration a spot will be reserved. If the workshop is already full, this registration will place you on the Wait List.
How did you hear about this workshop?
Demographic Information
We strive to serve our diverse community. If comfortable, please share more about your family to help us assess and improve our community connection.
Does Household qualify for Free or Reduced Lunch?