2012 Kamp Registration

AVRA KEDAVRA KAMP 2012 www.akkamp.com

Who: 8 – 12 year olds (maximum: 12 kids per week)

What: A literary arts camp featuring the novel called …Sorry, can’t tell you. Must be kept secret until the last minute. Can give a hint though: Slipsunder

Where: The Discovery School at the Leavenworth Fish Hatchery

When: Daily 10:00 – 3:00

1) 10-12 (13) year old BOYS: July 9 – 13, 2012

2) 10-12yearoldGIRLS:July16-20,2012

3) 8-10yearolds,CO-EDS:July23-27,2012

*Every Friday, there is a public presentation of our poems and stories and other wackiness we have dreamed up throughout the week – usually it is a participatory event with parents, grandparents, brothers, sisters, …

Cost: $150 per child for the week + some supplies (Scholarships are available. Please call Dr. Fu at 548-0606.)

Contact: Amy Carlson, Director & Certified Teacher @ 548-0606, or Margaret Neighbors, Registrar @ 548-0166

(each week additional staff will include 2 junior counselors and parent volunteers)



2012 Avra Kedavra Kamp Registration



Parent/Guardian Name & Relationship:

Mailing Address:

Phone: (home/cell)



First Kamper Age Session


Second Kamper Age Session

Please list any allergies and/or medical conditions:

Emergency Contact:

Insurance Company & Policy #: ________________________________________________________________________

Payment Details: Spots fill fast, so don’t waitAs each camp closes, it will be posted as ‘closed’ on the Avra Kedavra Kamp website: www.akkamp.com Keep an eye out.

*Total amount enclosed for camp sessions (@$150/ea) = _________________________

*Make checks payable to Avra Kedavra Kamp and send to AKKamp 324 Tumwater Drive Leavenworth, WA 98826 along with your registration. Thank you.

*Cancellation Policy: No refunds unless there’s death or dismemberment. We really spend a lot of time and energy getting ready for a certain number of kids. Thanks.

Revised: January 15, 2012

Volunteer Opportunity: Thanks to the parents, this Kamp is made possible! This year we will need help with snacks, crafts, and just plain ‘ol presence. Can you help for a day, two, all week? Please, in the big blank space on the back, list times you may be available. THANKS!!! We need you.


Waiver of Liability

My child has my permission to participate in the 2012 Avra Kedavra Kamp in Leavenworth, WA. I hereby release, waive, discharge, and covenant not to sue Avra Kedavra Kamp or Cascade School District or Leavenworth Fish Hatchery, its officers, servants, agents, employees and anyone they sponsor from any and all liability, claims, demands, actions and causes of action whatsoever arising our of or relating to any loss, damage, or injury that may be sustained by my child, or to any property belonging to me, while participating in the Kamp, or while in, on, or upon the premises where the Kamp is being conducted, while in transit to or from the premises, or in any place or places connected with the Kamp. I am fully aware of risks and hazards connected with being on the premises and participating in the Kamp.


Photo/Art Release

I release, for non-commercial use, any photographs taken of my child participating in Kamp. Artwork/poetry created by my child may be used in a public gallery with credit.


Revised: January 15, 2012


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