Fill out the registration form below. All fields are required.

Camper's Name:
Nickname:
Male Female 
Date of Birth:
Age:
Grade completed by June '13:
Street Address:
City:
State:
Zip:
Home Number:
Mobile Number:
Primary Email:    
Special Dietary Needs:
School Currently Attending:
Please indicate any emotional, behavioral or logistical issues that may affect the camp experience or that would help us help him/her have a great time at camp:
 
How did you hear about us?
Mother's Name:
  Home Number: Work: Mobile:
       
Father's Name:      
  Home Number: Work: Mobile:
       
Emergency Contact (Please provide the name of someone not listed above – parents/guardians listed above will be notified first.)
Name: Relationship:
  Home Number: Work: Mobile:
       
Please send my confirmation packet via:    
  Mail Email 
       

Liability Release, Payment, Refund and Cancellation Policies
I, as a parent or guardian of this camper, understand that Kids Wealth International Club, Inc. takes reasonable precautions to insure that KWIC Camps and activities are conducted by qualified personnel in a safe and responsible manner. However, I further understand that any activity or games involving kids involve certain risks.
These activities or games include, but is not limited to: ball toss, arts and crafts, game of trust (kids holding each others weight), musical chairs, games of rapid movement (find the empty spot in a circle before someone else does). I recognize these risks and agree to assume these risks by allowing my camper to attend programs administered by Kids Wealth International Club, Inc. I hereby release, indemnify, and hold harmless Kids Wealth International Club, Inc. their owners, officers, agents and subcontracted trainers, from all liability for damage, injury, or illness to my camper or his/her property relating to or deriving from my camper’s presence at programs administered by Kids Wealth International Club, Inc.
My payment accompanies this application and will hold my camper’s place. I understand that the cancellations and refunds can be given only as per the following timetable: 100% refund 60 days prior to camp; No Refund 59 days or less prior to camp. I understand that cancellation must be in writing (including email) or by phone call to (877) 594-2543.
I also understand that should my camper be required to leave camp before the end of a session or is asked to leave because of disruptive behavior, there will be no refund. In the rare event of a cancellation of camp due to weather-related conditions or the minimum attendee requirement is not met, a full refund will be given. Any returned or bounced checks will be charged a $50 fee to cover bank costs associated with the bounced check.
Consent is hereby given to Kids Wealth International Club, Inc. and trainers to seek medical aid in case of an emergency.
Checking this box is acknowledgment that I agree with the contents of this application including the Liability Release and Payment, Refund and Cancellation Policies.

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Raising Wealthy Kids Book
Upcoming Events
World of Wealth Mini-Camp
April 29 - 1pm to 4:00pm, Ages 8-14

Click here for more info