Potomac Valley Audubon Society · 2022 Discovery Camp Registration

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When creating the form, enter pertinent information here. It is used when confirmations are sent to the registrant.

Form Data (Visible)

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Parent/Guardian Contact Information

Parent/Guardian Name

*

First Name

Last Name

Parent/Guardian Email

*

Verify Email

*

Parent/Guardian Phone

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Membership

PVAS Members can opt to receive updates about activities and upcoming events, membership pricing on events, and the satisfaction of knowing their support makes our programs possible.

Are you a PVAS Member?

Yes

No

Thank you!

Joining PVAS is the best way to stay up-to-date on our activities and upcoming events, plus, your member dues support our programs and operations.

www.potomacaudubon.org/support/become-a-member/.

T-shirts	Quantity
$10 - Youth Extra Small
$10 - Youth Small
$10 - Youth Medium
$10 - Youth Large
$10 - Adult Small
$10 - Adult Medium
$10 - Adult Large
$10 - Adult Extra Large

Registrant Information

Relationship

*

I am this child's ...

Parent

Grandparent

Aunt/Uncle

Sibling

Other Guardian

Child's Name

*

First Name

Last Name

Birth Date

*

(mm/dd/yyyy)

Child's Gender Pronouns

*

School

Please indicate the school that your child will enter in the 2022-2023 school year.

Entering grade

*

Please select the grade that your child will enter in the 2022-2023 school year.

Allergies (Type NO if none)

*

Disabilities or Special Needs (Type NO if none)

*

Medications Child Currently Takes (Type NO if none)

*

Who Else May Pick Up Child? (1)

Phone (1)

Who Else May Pick Up Child? (2)

Phone (2)

Emergency Contact

Please name someone besides registering parent/guardian.

Emergency Contact's Name

*

First Name

Last Name

Emergency Contact's Phone

*

Emergency Contact's Relationship to child

*

Select Sessions below

Important:

You must complete the "Entering Grade" question above in order to see the sessions that are available for the child you are registering.

We want to be able to provide the camp experience to as many different children as possible and ask that you register your child for no more than two camp sessions.

You will need to complete a separate form for each child you are registering.
After completing the "Entering Grade" question, all sessions available will be listed below.
All camp sessions are 9:00 a.m. - 3:00 p.m. with the exception of Sensational Senses Camps which are 9:00 a.m. - 1:30 p.m.
Sessions will be held at Yankauer Nature Preserve (438 Whitings Neck Road, Martinsburg, WV) and at Cool Spring Preserve (1469 Lloyd Road, Charles Town, WV).
Sessions are limited in terms of how many children may attend. Available spots per session are shown below.

Scholarships

If you would like to apply for a scholarship, please do not register here. Please fill out the Scholarship Application form and indictate the sessions you would like to register for on that form.

#7 Wild about Water \| Session 2 \| July 25-29 \| Cool Spring Preserve	Quantity
$175 - PVAS member price
$195 - General public price

#12 Earth Art \| Session 3 \| July 25-29 \| Yankauer Preserve	Quantity
$175 - PVAS member price
$195 - General public price

#18 Nature Sleuths \| Session 2 \| July 18 -22 \| Yankauer Preserve	Quantity
$175 - PVAS member price
$195 - General public price

#20 Dirt Don’t Hurt \| Session 2 \| July 18 -22 \| Cool Spring Preserve	Quantity
$175 - PVAS member price
$195 - General public price

Terms and Conditions

Equity, Diversity & Inclusion Policy

The Potomac Valley Audubon Society (PVAS) does not exclude, deny benefits to, or otherwise discriminate against any service recipient, applicant, program staff, or the public on the basis of race, color, religion, national or ethnic origin, disability, age, sex, gender identity and expression, sexual orientation, political affiliation, or veteran status.

Cancellation Policy

PVAS may cancel a program if:

West Virginia Governor issues a Stay at Home Order or an order restricting group size;
hazardous weather that would create unsafe road conditions or unsafe conditions for being outside is forecasted;
a staff member critical to conducting an event is diagnosed with an active case of COVID-19;
the session doesn’t meet PVAS's registration number minimum.

Registrants will be notified by email of any cancelations by 5:00 p.m. the evening before the program.

If PVAS cancels this program and a registration fee has been paid, 100% of your payment will be refunded.

For cancellation requests by registrants, our non-refundable registration fee is $25. You can now cancel up to one week before the start of a camp session to receive your full refund minus the non-refundable registration fee.

*We understand that last minute cancellations might need to happen, but please try to let us know as soon as possible, so that depending on the circumstance, we can open the spot to someone else.

Behavior Policy

Inappropriate behavior will not be accepted or tolerated from any participant in our programs. Inappropriate behavior includes but is not limited to:

use of foul language
hurting or teasing other participants and/or animals
disrespecting or threatening a staff/counselor/director/volunteer/camper/student
wandering away from the group
fighting
destroying camp equipment.

Discipline Policy

On a child's first offense, the child will receive a warning from a staff member.
On the second offense, the child will be given a time-out and/or be restricted from participating in the current activity. A staff member will discuss with the child what he/she did wrong and allow them to reflect on the situation. The program director will also be informed. The parent will be notified of the incident at the end of the day.
On the third offense, or if the child refuses to cooperate in time-out, the child will be sent to the program director, and the incident will be recorded. In addition, a note will be sent home that must be signed by the child's parent or guardian.
On the fourth offense, the child's parent or guardian will be called to collect the child. At that time it will be determined, based on the situation, if the child will be allowed to return on subsequent days. If the child is dismissed from a program, no refund will be given.

Late Pick Up Policy

A $10/per child late fee will be assessed for every 15 minutes after 3:00 pm for children not yet picked up.

Electronics

No electronic devices (cell phones, iPads, game consoles, etc.) are allowed to be used at PVAS programs by attending children. If a child is found using these items during camp: on first offense, the program director will hold the item until the end of the day and it will be returned directly to the child's parent or guardian; a second offense, the item will be confiscated until the end of the day and the child's parent or guardian will be called; a third offense will result in child being dismissed from the remainder of the program without a refund. PVAS is not responsible for lost, stolen or damaged items.

Terms and Conditions Acceptance

*

I agree to all of the Terms and Conditions listed above.

Permission to Photo/Video

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Indicate whether you agree to allow PVAS to take and utilize photographic images of the registered individual(s) for the purpose of promotion and publicizing our programs and events.

I agree to use of image.

I do NOT agree to use of image.

Permission to Consume Wild Foods

*

I give my child permission to consume wild edible foods such as blackberries, wine berries, cattail, water cress, dandelion leaves, tea made from sassafras roots etc. I understand that my child will be taught to follow the camp rule that no wild foods can be consumed without permission from a camp counselor or the camp director.

Yes

No

Coronavirus/COVID-19 Warning & Disclaimer

PVAS has developed COVID-19 Policies and procedures for program operations based on CDC, state, and local health guidelines. Please review these before agreeing to accept and abide by them at the event you are registering for.

COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in our programs could increase the risk of contracting COVID-19. PVAS in no way warrants that COVID-19 infection will not occur through participation in our programs or accessing PVAS facilities.

COVID Release Acceptance

*

I understand the above and assume said risks associated with COVID-19 on behalf of all those I am registering. I have read the PVAS COVID-19 policies and agree that all people I register will understand and agree to abide by these policies.

Release of Liability

Medical

If my child is taking a prescribed medication, I give permission for the staff designated by the camp director to administer prescription or over-the-counter drugs that my child must take while at camp. All medications must be in their original container and clearly marked with my child’s name.

If my child needs assistance with sun-screen and/or bug repellent application, I give permission for the camp staff to help my child apply the product(s) that I have provided.

In the event of an emergency, I understand that every effort will be made to contact the parent/guardian as soon as possible. In the event that neither I nor my emergency contact can be reached, I hereby give permission to the physician selected by the camp director to secure proper treatment, including x-rays, hospitalization, anesthesia, surgery or injections of medication for my child.

First Aid

I give permission for the staff designated by the camp director to administer basic first aid to a child in need of care. This includes but is not limited to: cleaning cuts, applying bandages, removing ticks, and applying icepacks. All injuries and administered first aid will be recorded and the parent will be notified upon pick-up. If my child is feeling ill or has an injury that the camp director feels I should be made aware of prior to pick up, I understand that I will be called and may be asked to pick up my child from camp.

Release of Liability

*

I agree to the above release of liability terms.

Electronic Signature

*

Scholarship Donation

We want all children to have a chance to come to camp no matter their financial circumstances . Scholarships to attend camp are available for families with financial need.

If you would like to help sponsor a child to attend camp, you can make a donation here:

Donation

$0 - No thank you

$10

$25

$50

$100

$175 - Full scholarship