2024 DANA Summer Camp Registration

Summer Day Camp Registration For

Session A: June 17th through 21st

Session B: June 24th through June 28th

9 am - 3 pm

Ages 7 - 12 years old

DANA Adobe at Historic Rancho Nipomo is dedicated to connecting children with nature, culture, history and even a little science all expereince through life on the Rancho!. Campers will learn about the local wildlife and their habitats, as well as life on the Rancho in early Californio days. All of this is accomplished through hands-on activities, interactive games and exploration.

Join us for 2 weeks of fun at DANA Summer Day Camp

Cost:

I week of camp: $300, Additional Child $250

2 Weeks of camp: $550, Additional child $500

Registration non-refundable after June 3, 2024

Payment is due upon registration or your campers spot will not be saved

Which session would you like to register for? *

Please select the session(s) for your child(children)

Session A

Session B

Registration fee *

$300 - 1 child for 1 week

$550 - 2 children for 1 week

$800 - 3 children for 1 week

$550 - 1 child for 2 weeks

$1,050 - 2 children for 2 weeks

$1,550 - 3 children for 2 weeks

1. Child's Information

Child's Name: *

First Name

Last Name

Date of Birth *

(mm/dd/yyyy)

Allergies/Medical Concerns:

2. Child's Information

Child's Name

First Name

Last Name

Date of Birth *

(mm/dd/yyyy)

Allergies/Medical Concerns

3. Child's Information

Child's Name

First Name

Last Name

Date of Birth *

(mm/dd/yyyy)

Allergies/Medical Concerns

Primary Parent/Guardian's Contact Information

Parent/Guardian Name: *

First Name

Last Name

Phone #: *

Email: *

Verify Email *

Address: *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Secondary Parent/Guardian's Contact Information

Parent/Guardian Name:

First Name

Last Name

Phone #:

Email:

Verify Email

Address:

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Are there any behaviors/concerns/Special Needs the staff should be aware of?

Other significant information about your child that would be helpful to know?

Medical Treatment Authorization

In the event that my child needs immediate medical attention for injuries received while participating in a program at the DANA Adobe at Historic Rancho Nipomo, I give my permission for the Dana Adobe Nipomo Amigos Inc. and DANA Adobe at Historic Rancho Nipomo staff and volunteer members to administer necessary medical treatment. Dana Adobe Nipomo Amigos Inc. and DANA Adobe at Historic Rancho Nipomo staff and volunteer members may also admit my child to a hospital emergency room for emergency medical treatment without my consent if I cannot be reached to give permission.

Preferred Hospital: *

Health Insurance Company & Policy # *

I agree to the above terms and conditions

Parent Authorization

Medical & Liability Release

The undersigned agrees to hold the Dana Adobe Nipomo Amigos Inc., any officer, employee or volunteer thereof harmless from any claim for injury or accident to the above-named child/children arising out of or in any way connected with the named activity. I recognize that this program may have some inherent risks and I accept the responsibility to identify those risks and accept them. In case of an accident arising out of an activity, medical assistance may be administered to the person named herein. This registration form will act as a medical release. If the participant is under 18, a parent or guardian must sign a release.

Official Nondiscrimination Statement

Dana Adobe Nipomo Amigos Inc. does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, subcontractors, vendors, and clients.

Photo Release Waiver

I give Dana Adobe Nipomo Amigos Inc. and DANA Adobe at Historic Rancho Nipomo permission to publish in print, digital, or video format the likeness or image of my child. I release all claims against Dana Adobe Nipomo Amigos Inc. with respect to copyright ownership and publication including any claim for compensation related to use of the materials.

I hereby consent and agree that Dana Adobe Nipomo Amigos Inc., its employees or volunteers, or agents have the right to take and use photographs, videotape, audiotape or digital recordings of my child while on the Dana Adobe Nipomo Amigos property to be utilized in the development of marketing materials not limited to newsletter, website, emails, press releases, and/or TV.

I agree to the above terms and conditions

Assumption of the Risk and Waiver of Liability

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance to DANA Summer Day Camp at DANA or participation DANA programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless DANA, its employees, volunteers agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of DANA , its employees, volunteers, agents, and representatives.

I agree to the above terms and conditions

Checkboxes *

Please Choose a T-shirt size

Child's Small

Child's Medium

Child's Large

Adult Small

Adult Medium

Adult Large

How did you hear about Camp? *

Facebook

Instagram

DANA website

Friend

Flyer

Add 3% to my total amount to help cover the payment processing fees