2024 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 $30 deposit so we can enroll your child in camp, otherwise their space may not be guaranteed. Thank you.

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:

Earth Ways Camp July 22 - 26, in Cottage Grove

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 free 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:

Coupons are applied later, to your final payment one week before camp starts.

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2024 Summer Camp Registration

Summer Camp Registration Form 2024 (New)

Payment

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