2025 Summer Camp Registration

Please fill out the form below to register your child for summer camp. You will be asked for payment details as well. Please pay the $35 deposit so we can enroll your child in camp, otherwise their space may not be guaranteed. Thank you.

Summer Camp Registration Form 2025

"*" indicates required fields

Parent Name*

First Last

Email*

Second Parent Name*

First Last

Email*

Please select camp you are registering for:

Pioneer Homesteading Camp July 21 - 25

Opal Whiteley Nature Fairies Camp July 28 - Aug 1

Earth Ways Camp Aug 4 - 8

Child's Home Address*

Street Address Address Line 2 City State ZIP Code

We are enrolled members of an American Indian Tribe and have a registration card for our child.

yes

(For Earth Ways summer camp this entitles you to discounted tuition.)

Phone: Day time best number*

Phone: Day time best number second parent

Phone: Evenings/Alternate

Child's Name*

First Last

Age:*

Second Child's Name

First Last

Second Child's Age:

Please explain any custody issues we should be aware of:

Emergency Contact Person Name:*

First Last

Their Phone:*

Relationship to Child:*

Any Extra Information about Emergency Contact Person:

School your child(ren) attend(s), or mark Home schooled:*

Dietary Restricions for your child(ren):

Allergies, either known or suspected:*

Medications child(ren) will be taking:*

If this information changes, please notify us before camp begins. We should oversee or administer all medications.

Any physical ailments or restrictions on activities we should be aware of:*

Please let us know anything else we should know for your child to be sucessful in our camps:*

Persons Authorized to pick up your child other than parents listed on this form, and their cell phone numbers:*

Sign this form by typing your name below:*

Payment

Please pay ONLY the Deposit OR the Full price when registering. DO NOT pay both!

Deposit Only (we will bill you for the remainder 2 weeks before camp)

Price: $35.00

Please enter 1 for a single child, or 2 for two children, etc.

Full Price One Child

Price: $245.00

One Summer Camp Registration- Do not pay Deposit if you are paying Full Price. In the Quantity field put 1.

Siblings Price

Price: $210.00

All siblings must be enrolled in the same camp for the discount. $210 each for both (or all) kids. Enter the number of siblings you have in the camp.

Coupon Code or Referred By:

Donation to our Scholarship Fund for low-income families (optional)

Total

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2025 Summer Camp Registration

Summer Camp Registration Form 2025

Payment

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