Northwest Danish Association · Dane Camp for Little Vikings 2017

Dane Camp for Little Vikings 2017

Registration Form

Please fill out one form per camper.
Dane Camp is provided by Northwest Danish Association

Ages: 5-10

Dates: July 31st to August 4th 2017

Location: Seattle Danish Center, 1833 N 105th Street Suite 205, Seattle, WA 98133

Apply early to guarantee a spot for your child. Registration fee increases after July 7th 2017.

Note: This online application requires applicants to upload a signed release form below. It is helpful if you have the signed form ready to upload before beginning the application.

Contact Information

Camper Name

First and Last Name

Parent/Guardian

First Name

Last Name

Other Parent/Guardian

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Cell Phone

Home Phone

Work Phone

E-mail

Check here if you do NOT want to receive e-bulletins with updates on NWDA events and programs

Person(s) authorized to pick up camper:

First and Last Name(s)

Registration Fees

Camp Fee

$225 - NWDA Member* (CAMPER or PARENT of camper must be CURRENT 2017-2018 member of the Northwest Danish Association)

$250 - Non-Members

*Not a member? Visit www.northwestdanish.org/membership/ to become a current 2017-2018 NWDA member

Extra Camp Activities (Optional)

Check the boxes to request before and/or after camp activities. Fee: $10/hour payment due at the end of each day.

Before Camp (8:00 am to 9:00 am)

After Camp (4:00 pm to 5:00 pm)

Emergency Contact Information

Emergency Contact Name

First Name

Last Name

Emergency Contact's Relationship to Camper

Emergency Contact Phone Number

Camper Information

Camper Age

Camper age at start of camp (as of July 31st 2017)

Camper Birthday

Month/Day/Year

Camper Sex

Camper's Fall 2017 Grade Level

Camper Level of Danish

Choose one:

Camper does not speak Danish

Beginner

Advanced

Fluent

Camper t-shirt size (children's)

Choose one:

Small

Medium

Large

Camper Health Information

Please list any known allergies (food, medicine, etc.):

Please list any medication the camper is taking:

Special diet request:

None

Vegan

Vegetarian

Other

Other special diet request, please describe:

Physical, behavioral, or emotional concerns:

Yes

If yes, please provide an explanation:

Family Health Insurance Company

Health Insurance Policy Number

Release Form

Please sign the medical release, liability waiver, and photography release form and upload it below. The form can be downloaded here.

Upload the signed release form here:

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