Camp Registration Form

You can pre-register for any of  Earth, Glaze & Fire’s Camps using the form below. This form is needed regardless of how you pay for the registration – paypal, email or snail mail.   Note: Once you submit the form you will be redirected to the thank you page — if this does not happen, and you can still see the form, please check to see that there are no errors, or missing information (if you notice any ‘red lettered’ instructions these will explain what problems there may be)

If, by any chance, you do not receive a reply from us within 72-hours please call us directly on: 540-878-5701 (or stop in at the studio).

Deposit Required

A $75.00 deposit per person is required to reserve your space in summer camp. You can pay your deposit one of two ways:

1) Pay online using our secure online payment button below, or
2) Mail or bring your deposit payment to Earth, Glaze & Fire to 19 Main Street, Warrenton, Virginia. We accept checks, Visa and MasterCard.

Secure Online Deposit Option: Paypal

If you would like to pay your summer camp deposit online, please click the button below. It will take you to a secure online payment page, where you can pay by credit card. You do not need to have a paypal account to use this payment option.  Please ensure that you also complete the form below. It provides us with important information!!!

Online Registration Form

Please complete this form and submit it to us to reserve your space in summer camp.

Kids Summer Camp Pre-Registration:

(*denotes required field)

Name:*

E-Mail Address:*

E-Mail Address again:*

Please enter your E-mail Address a second time.

Your Telephone Number*

Name of Child #1*

Age of Child #1*

Name of Child #2

Age of Child #2

Name of Child #3

Age of Child #3

I have read and accept Camp Policies*

List the Camp Dates you'd like to attend*

Message:*

CAPTCHA Code:*

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