Please register your child(ren) for summer camp using the form below.

You will be taken to Paypal to complete your registration. Deposit is required to hold your space in camp.

Summer Camp Registration Form 2024 (New)

"*" indicates required fields

Parent Name*

First Last

Email*

Second Parent Name*

First Last

Email*

Please select camp you are registering for:

Pioneer Homesteading July 8 - 12

Earth Ways Camp July 22 - 26

Opal Whiteley Nature Fairies Aug 5 - 9

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 half off 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 enter $30 deposit for each child. For instance, if you have two children to register, put in $60.

Do you want to cover the transaction fees?

Yes, I want to cover the transaction fees.

Payment Amount*

Total Payment (no transaction fees paid for)

Price: $0.00

Total Payment (with transaction fees paid for)

Price: $0.00

Coupon Code or Referred By:

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Please register your child(ren) for summer camp using the form below.

Summer Camp Registration Form 2024 (New)

Payment

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