Fred L. Waterman Conservation Education Center · Waterman Explore Conservation Camp Wk 3 2021 Application

Waterman Explore Conservation Camp August 16-20, 2021

Payment Method

Please select how you plan to pay your camp fee

$200 Electronically Through This Form

I plan to mail a check

I plan to pay at the Interpretive Center

Amount Paid Online (Please Choose One)

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$200 - 1 week Waterman EXPLORE tuition.

$0 - I will pay be check or cash at a later date.

Camp Age

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Please select how old your child will be when they come to camp.

6 years old

7 years old

8 years old

9 years old

10 years old

11 years old

Camper Information

Camper Name

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First Name

Last Name

Date

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Camper Date of Birth

Sex

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Male

Female

Shirt Size

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What size shirt would you like for your child?

x-small

small

medium

large

x-large

Parent's Information

Mother's Information

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First Name

Last Name

Father's Information

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First Name

Last Name

Home Phone

Email

Verify Email

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Mother's Employment Information is Required and Will Be Kept Strictly Confidential

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Father's Employment Information is Required and Will Be Kept Strictly Confidential Copy

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Mother's Work Phone

Father's Work Phone

Person/s Authorized to pick up camper

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First Name

Last Name

Relationship to child

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Person/s Authorized to pick up camper

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First Name

Last Name

Relationship to child

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Person/s Authorized to pick up camper

First Name

Last Name

Relationship to child

Person/s Authorized to pick up camper

First Name

Last Name

Relationship to child

Health Care Provider/Insurance

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Please provide-Physician Phone Number, Preferred Hospital and Insurance Company

Medical Information

Allergies

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Allergies: (please write "none" if no allergies)

Medications

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Medications: (list with doses and times, or write "none" if no medications)

Medical or Behavioral Conditions

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Medical/ Behavioral Conditions: (please list "none," if no conditions)

Terms and Conditions

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I give my permission for my child to participate in the Summer Camp Program at Waterman Conservation Education Center. This child, to the best of my knowledge, is in good physical condition and is capable of hiking the trails and other planned outdoor activities. I understand that hiking and other activities associated with an outdoor camp have an inherent risk factor, and that all appropriate precautions will be taken for the safety of my child. I give permission to the Waterman Center staff, volunteers and /or medical staff to administer proper medical assistance to the named above participant if needed. I agree not to hold the Fred L. Waterman Conservation Education Center, Inc. or any of their agents responsible in the event of injury to my child. In addition, I authorize the verification of the information provided on this form. I grant permission for video recordings and digital photographs to be taken of my child or my child’s work as part of her/his participation in the Waterman Conservation Education Center Nature Camp. I authorize the Waterman Conservation Education Center to use my child’s image for websites and/or in printed promotional materials without further consideration and I acknowledge Waterman Conservation Education Center’s right to treat the media (such as cropping) at its discretion. I understand that once my child’s image is posted on the Waterman Conservation Education Center’s website, the image could possibly be downloaded by a third party. I agree that I will not hold Waterman Conservation Education Center responsible for any harm that may arise from such unauthorized reproduction.

I agree

Discipline Policy

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Waterman Center and our Camp Program Director work hard to ensure the safety and happiness of our campers. If a child manifests poor behavioral decisions we will make every effort to resolve the problem. In the event, the behavior persists or worsens, expulsion may be warranted for the good of the other campers. Reasons for expulsion include but are not limited to, physical violence of any kind, biting, inappropriate language, inappropriate touching, bullying, abusive behavior, tantrums, and/or angry outbursts, campers not following Covid-19 infection control and safety procedures. Expulsion does not qualify for a refund. All discipline decisions will be at the discretion of the Camp Program Director.

I agree

Sunscreen/Bug spray Policy

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Use of Sunscreen/bug spray: I give permission for my child to carry and self-apply sunscreen/bug spray. The sunscreen will only be used to prevent overexposure of the sun. The bug spray will only be used to reduce the possibility of bug bites. Only sunscreen and bug spray approved by the FDA for over the counter use will be permitted for use by the child. Reminder: Sunscreen and bug spray are considered a drug and shall be checked and logged by Waterman Conservation Education Center staff. Furthermore, Waterman Conservation Education Center staff will not be able to aide in application of sunscreen or bug spray.

I agree

File Upload

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Please attach current health records as well as immunization records for your child.

Inhaler

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My child is independent in the use of his/her inhaler. My child does not need assistance in its use. The inhaler will be kept with my child’s counselor during camp hours.

I agree

My child does not use an inhaler

Covid-19 Waiver

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I acknowledge that the novel coronavirus (“COVID-19”) is a global pandemic and that infections have been confirmed throughout the United States and Internationally, including in New York State. I understand that Waterman Conservation Education Center cannot guarantee my safety or immunity from infection. With this understanding, I knowingly and voluntarily waive and release Waterman Conservation Education Center and their employees from any and all present and future claims of any type, including for any harm or loss, economic loss, personal injury, disease, or death.

I agree

Acknowledge Form

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In checking that "I agree", I certify my understanding of this form and agree to instruct my child to abide by all the instructions given to my child by Waterman Conservation Education Center volunteers, employees, or agents during my child’s stay at camp. I also acknowledge that all information has been filled out to the best of my ability and knowledge.

I agree