2024 Dirt Day Registration

We are offering two sessions of camp for kids ages 8-13 who love to wander, explore, and get a little messy. This one-day camp for young environmental stewards and scientists will include free choice time, outdoor exploration, creative science and take-home projects. We will actively explore soil, water, geology, fossils, and underground ecosystems.

Participants will bring a sack lunch and Prairie Loft will provide a healthy snack. Enrollment is filled on a first-paid, first-served basis. Adult presence each day will include at least three Prairie Loft staff and volunteers.

Registered families will receive further information prior to camp.

Scholarships may be available. If interested, please contact us before completing this form.

Fee: $35/child *	Quantity
$35

Contact Information

Parent/Guardian 1 *

First Name

Last Name

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email *

Verify Email *

Primary Daytime Phone *

Alternate Daytime Phone

Relationship to Camper(s) *

Contact Information

Parent/Guardian 2 (optional)

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Verify Email

Primary Daytime Phone

Alternate Daytime Phone

Relationship to Camper(s)

Camper Information

Camper's Name *

First Name

Last Name

Nickname (optional)

(how it should appear on child's name tag)

Tell us about you child

My child is..

Easy Going

High Energy

Hesitant to try new things

Outgoing

Shy

Other (please elaborate under additional information)

Camper's Birthdate *

(mm/dd/yyyy)

Age as of June 1 *

(8-13 years only)

Camper's Gender *

Camp Session *

Please enroll my child in the following session from 9:00-4:00 pm.

Camp 1: Friday, June 14

Camp 2 Friday, July 19

Camper Information (2)

Camper's Name (2) *

First Name

Last Name

Nickname (optional)

(how it should appear on child's name tag)

Tell us about you child

My child is..

Easy Going

High Energy

Hesitant to try new things

Outgoing

Shy

Other (please elaborate under additional information)

Camper's Birthdate (2) *

(mm/dd/yyyy)

Age as of June 1 *

(8-13 years only)

Camper's Gender (2) *

Camp Session (Camper 2) *

Please enroll my child in the following session from 9:00-4:00 pm.

Camp 1: Friday, June 14

Camp 2: Friday, July 19

Camper Information (3)

Camper's Name (3) *

First Name

Last Name

Nickname (optional)

(how it should appear on child's name tag)

Tell us about you child

My child is..

Easy Going

High Energy

Hesitant to try new things

Outgoing

Shy

Other (please elaborate under additional information)

Camper's Birthdate (3) *

(mm/dd/yyyy)

Age as of June 1 *

(8-13 years only)

Camper's Gender (3) *

Camp Session (Camper 3) *

Please enroll my child in the following session from 9:00-4:00 pm.

Camp 1: Friday, June 14

Camp 2: Friday, July 19

Camper Information (4)

Camper's Name (4) *

First Name

Last Name

Nickname (optional)

(how it should appear on child's name tag)

Tell us about you child

My child is..

Easy Going

High Energy

Hesitant to try new things

Outgoing

Shy

Other (please elaborate under additional information)

Camper's Birthdate (4) *

(mm/dd/yyyy)

Age as of June 1 *

(8-13 years only)

Camper's Gender (4) *

Camp Session (Camper 4) *

Please enroll my child in the following session from 9:00-4:00 pm.

Camp 1: Friday, June 14

Camp 2: Friday, July 19

Camper Information (5)

Camper's Name (5) *

First Name

Last Name

Nickname (optional)

(how it should appear on child's name tag)

Tell us about you child

My child is..

Easy Going

High Energy

Hesitant to try new things

Outgoing

Shy

Other (please elaborate under additional information)

Camper's Birthdate (5) *

(mm/dd/yyyy)

Age as of June 1 *

(8-13 years only)

Camper's Gender (5) *

Camp Session (Camper 5) *

Please enroll my child in the following session from 9:00-4:00 pm.

Camp 1: Friday, June 14

Camp 2: Friday, July 19

Local Emergency Contact

Authorized to act on behalf of parent(s) if they cannot be reached. Must be an individual living outside the camper's home.

Name *

First Name

Last Name

Relationship to Camper *

Phone *

Additional Information

Health Information (Any allergies, sensitivities, physical/cognitive conditions or other health issues that program leaders should know about?)

Please use this space to share health info and/or other comments & questions.

Does your camper carry an epipen, inhaler, allergy medication, or other medication that may be administered during camp times? *

Yes

Prairie Loft may need to request additional information prior to camp.

Payment and Refund Policies

Payment is due at this time in order to complete the registration unless other arrangements have been made. Should the registration be canceled, the refund policy will be as follows, or the registration can be donated to (and greatly appreciated by) Prairie Loft. No partial refunds are given if the camper attends only part of a session.

75%	Cancellation made within 1 month of registering
50%	Between 1 month and up to 2 weeks before the session
25%	Less than 14 days before the session

Would you like to donate to provide scholarships for other campers? Your support and generosity makes fulfilling our mission possible.

$50

$20

$10

Parent/Guardian Authorizations

My child (or ward) has permission to participate in the camp activities during the sessions and programs in which they are enrolled. I understand that outdoor activities may have inherent risks and that reasonable measures will be taken to safeguard the health and safety of all participants.

I will assure that my child is properly prepared for all activities, including having proper clothing and equipment, being in good health and willing and able to participate in camp activities.

I understand that I will be notified as soon as possible in case of any emergency, unusual illness, or injury affecting my child. In the event that I cannot be reached, I hereby authorize the alternate contact people to act on my behalf, and authorize the camp to contact a physician if necessary. I hereby give Prairie Loft staff and volunteers permission to provide appropriate routine and emergency care for my child.

I understand that my child may appear in photographs or videos while participating in camp activities. Prairie Loft may use the photo or film for publicity, promotional, or educational purposes.

Summer Camp Policies and Information *

I have read and understand the camp guidelines and practices outlined on the Summer Camp webpage (prairieloft.org/summer-camps).

If you do NOT want your child's photograph used by Prairie Loft, check here.

Please do NOT photograph my child

By typing your name here, you are agreeing to the terms above. *

Parent/Guardian electronic signature

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