Goshen College Summer Camp Registration GC Summer Camps 2024 Child's Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Name of Parent/Guardian* First Last Parent/Guardian's Phone*Parent/Guardian's Email School Child AttendsGrade Level for Fall 20241st2nd3rd4th5th6th7th8th9th10th11th12thPlease select which day camp you would like to register for.Read, Act, Create, June 3-7 (Grades 1-2)Outdoor Fitness, June 3-7 (Grades 7-8)STEM: Engineering & Mathematics, June 3-7 (Grades 4-6)STEM Lego Camp 101, June 17-21 (Grades 4-6)STEM Lego Camp 201, June 24 - 28 (Grades 7-8)Ethos STEM Camp, July 15-19 (Grades 3-6)ASL Camp 101, July 15 - 19 (Grades 6-8)Write on Sports, June 10-21 (grades 7-9) *FreeAll day camps are $50 unless otherwise marked. Scholarships are available. Please select which career camp you would like to register for.Rompiendo Barreras, Jun 3-24 (High School)Software/Coding, June 10-14 (High School)Authors in the Making, June 10-14 (High School)Filmmaking, June 24-28 (High School)ASL Camp 201, July 8-12 (High School)Young Entrepreneurs, July 8-12 (High School)Exercise Science, July 15-19 (High School)Poetry from Page to Stage, July 22-26 (High School)Write on Sports, June 10-21 (grades 7-9) *FreeAll career camps are $125 unless otherwise marked. . Scholarships are available. Race of childBlack/African AmericanWhiteLatino/Latina/LatinxAsianPacific IslanderAmerican Indian or Alaska NativeMixed RaceLiabilityList behavioral and/or disability issues. (include if your child has an IEP):List food or environmental allergies:List medical conditions:Injury* Yes, I give permission and will not hold anyone liable for injuries I hereby give my child permission to take part in Goshen College's Summer Camps. I will not hold the sponsor of this camp, the instructors, or Goshen College liable for injuries that might occur.Emergency ContactEmergency Contact 1* First Last Emergency Contact 1 Phone*Emergency Contact 2 First Last Emergency Contact 2 phoneTransportation InformationWhat are your means of transportation? Select one:*I will provide transportation to & from Goshen CollegeI request pick up at a to be determined central location in:My child is allowed to walk/bike home from the Goshen College campus. Goshen College will not be held liable for any incidents of harm or injury that could occur.Which Location:Elkhart. Goshen College will not be held liable for any incidents of harm or injury that could occur.Goshen. Goshen College will not be held liable for any incidents of harm or injury that could occur.Please designate up to three individuals who can pick up your child as well as a phone number for each person:Separate people with commas. Please limit to three (3) people.I understand that my child must be at the pick-up location promptly and if they are not there on time, I am responsible for getting my child to camp. I also agree to have an appointed person there to pick my child up at the specified time.* Yes, I agree No, I do not ConsentI hereby grant permission to Goshen College, and its employees, agents, and assignees, the right to photograph my child or use their picture for purposes of advertising, publicity, trade, or otherwise, as still photographs, transparencies, motion pictures, television, web images, or other media or means of reproduction, transmission, or exhibition. I release Goshen College, its employees, agents, associates, successors, and assignees from any and all claims for damages or compensation for any claims based on the use or sale of said materials. I hereby waive the right to inspect, approve, or edit said material.* Yes, I agree No, I do not I agree, on behalf of myself or my child, not to make any claims of any kind against Goshen College or any of its employees or agents for any loss or injury that my child might sustain while engaged in the Summer Camp program. I authorize such physicians or medical staff as Goshen College may designate to carry out any minor treatment and/or medical staff to provide any treatment deemed necessary for the well-being of my child.* Yes, I agree No, I do not Payment InformationWill you be needing a scholarship to cover the camp registration fee?NoYesRegistration Fee Price: $50.00 Write on Sports Fee Waiver Price: -$50.00 Write on Sports Fee Waiver Price: -$125.00 Registration Fee Price: $125.00 Total Registration Fee $0.00 Billing Address* Same as above Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Total Registration Fee $0.00 Privacy Policy AgreementBy submitting this form, I give permission for my form submission and visit to this website to be tracked, to have the data I provided and information about my browser stored, and for this information to be shared with select third parties as outlined in the Privacy Policy. 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