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Czech and Slovak school of Pittsburgh
Language Immersion Camp
May 19-21, 2023
Raccoon Creek State Park
Czech and Slovak Language Immersion Camp Registration Form
Please, fill out all information and return by April 5th, 2023
Registration begins on:
March 22nd, 2023,
for active members of Czech and Slovak School of Pittsburgh
March 29th, 2023,
for nonmembers/general public
THESE DATES ARE FINAL AND NO LATE REGISTRATION WILL BE ACCEPTED!!!!
Do not send payments with the registration form!
Receiving your registration form does not guarantee you a spot at the camp.
Please, wait for a confirmation email with the instructions on how to proceed with your payment.
*
Indicates required field
Child's name
*
First
Last
Date of birth (mm/dd/yyyy)
*
Child's Gender
*
Male
Female
Child's T-shirt size
*
--
Adult
Child
Youth
Child's T-shirt size
*
--
Small
Medium
Large
Extra Large
If more than one child from the family is attending, please fill here:
2nd Child's name:
*
First
Last
2nd Child's Date of birth
*
(mm/dd/yyyy)
2nd Child's Gender
*
Male
Female
2nd Child's T-shirt size
*
--
Adult
Child
Youth
2nd Child's T-shirt Size
*
--
Small
Medium
Large
Extra Large
3rd Child's name
*
First
Last
3rd Child's Date of birth
*
(mm/dd/yyyy)
3rd Child's Gender
*
Male
Female
3rd Child's T-shirt size
*
--
Adult
Child
Youth
3rd Child's T-shirt Size
*
--
Small
Medium
Large
Extra Large
What Language Do you Speak?
*
Czech
Slovak
Mother's name
*
First
Last
Mother T-shirt Size
*
--
Small
Medium
Large
Extra Large
Father's name
*
First
Last
Father T-shirt Size
*
--
Small
Medium
Large
Extra Large
(T-shirt size is needed only for parents staying at the camp)
Are parents accompanying a child(ren) to the camp?
If YES, please specify if only one or both parents will be coming!
*Please note that children 12 years and younger must be accompanied by at least one parent!
Are Parents Accompanying a child(ren)
*
Yes
No
If Yes One or Both?
*
One
Both
Parents Phone Number
*
Other Parents Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency contact Name (Not Parent)
*
Emergency contact Phone Number (Not Parent)
*
Email
*
Doctors Name
*
Doctors Phone number
*
Health Card #
*
*Health Card Must Be Brought to Camp
Any food/drug allergies? Does your child have a medical condition we should be aware of? Are there any other needs we should be aware of?
*
Accommodation has been reserved at the modern cabins in Raccoon Creek State Park.
However, due to a big interest in our camp, we made reservations for tents as well.
I am interested in staying at
Modern Cabins
(2 nights):
$50/bed (every person occupying a bed in the cabin will need to pay $50 for the whole weekend, meals are included in the price). We will try to accommodate requests and put people together in cabins, but you might be asked to share a cabin with other people.
I am interested in
SATURDAY Day Camp Only
(not staying overnight):
$20/person (children 2 years and younger do not pay), meals are included.
Tent site:
$30/ person/ whole weekend.
You need to provide your own tent
(meals are included in the price)
. The tent site is not within a walkable distance from the cabins and main activities-you need to drive 2-3 minutes. One of the modern cabins, as well as the big room we reserved for the weekend, will serve as a base for everyone’s needs during the day activities.
Choose One
*
Cabin
Saturday Only
Tent site
If you have any questions, feel free to email us at
skola@czechslovakschoolpgh.org
RIGHT TO USE IMAGES
I understand that the Czech and Slovak School of Pittsburgh may produce or participate in video, motion picture, audio recording, web pages, still photographs, broadcast, social media, and/or other publication which may involve the use of student's images, video, or voice. Such productions will be used for non-commercial education, exhibition, or promotional material and will not be sold for any reason. They may be copied copyrighted, edited, and/or distributed by the Czech and Slovak School of Pittsburgh, in the manner described above. By checking YES, and signing below, I grant Czech and Slovak School of Pittsburgh the right to use and re-use, in any manner, the video, motion picture, audio recording, web pages, still photographs, broadcast, social media, and/or other publication described above containing my child(ren)'s image or voice named herein. I waive the right of prior approval and herby release the Czech and Slovak School of Pittsburgh, its agents, or its designees from any and all claims for damages or remuneration of any kind based on the use of said materials. I have read the forgoing and fully and completely understand the contents thereof and accept or reject these terms and conditions as indicated below (please circle one)
Right to use images
*
Yes
No
Parent's initial:
*
Everyone attending our camp is expected to follow the camp rules, be on time, and actively participate in all camp activities.
Parent Signature
*
First
Last
Date
*
The Language Immersion Camp is partially
funded from the generous financial support of the
Ministry of Foreign Affairs of the Czech Republic.
Please click the button bellow to submit your registration.
If any of the required fields are missing or any field is entered incorrectly, you need to correct the highlighted fields before a successful submission.
A message will appear when your online application has been successfully submitted.
Submit
