Columbia Springs · 2020 Summer Nature Day Camp

Which sessions can your camper attend camp?

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Campers can only attend one session of camp but availability may vary. Please select ALL sessions of camp your camper COULD attend camp.

Session 1: July 6 - 10th

Session 2: July13- 17th

Session 3: July 20-27th

Session 4: July 27-31st

If you have a preference, which session is your 1st choice?

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Contact Information

Guardian's Name

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First Name

Last Name

Relationship to Camper:

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Email

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Verify Email

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Cell Phone

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Home Phone

Work Phone

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Are you (the guardian) the primary emergency contact?

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In an emergency, the primary emergency contact is:

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First Name

Last Name

Relationship to Camper

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Emergency Contact's CELL number

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Emergency Contact's HOME number

Emergency Contact's WORK number

Secondary Emergency Contact

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First Name

Last Name

Relationship to Camper

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Secondary Contact's CELL number

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Secondary Contact's HOME number

Secondary Contact's WORK number

Including yourself, please list the first and last name of each person authorized to pick your child up from camp.

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Camper Information

Camper's Name

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First Name

Last Name

Camper's Date of Birth

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(mm/dd/yyyy)

Camper's Gender:

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What grade is this camper entering in the upcoming academic year?

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What school does this camper attend?

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Camper tee-shirt size

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Does your child have a friend or sibling they would like to be paired with if possible?

(Cabins are generally divided by grade level)

Has your child attended camp at Columbia Springs in the past?

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If so, please tell us the year your child attended and the name of their group leader(s).

Please describe any special needs that we should be aware of (fears, behaviors, etc.):

Does your child require the assistance of a para-educator during the school year?

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Please let us know how you plan to accommodate their learning needs (para-educator present, etc).

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Has your child been tested and diagnosed for a food allergy by a health care professional?

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If NO, are there any food sensitivities or preferences you'd like us to know about:

If YES** please list food allergies below:

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Please list any physical/medical conditions that would be helpful for us to know about your child (recent injuries, allergies, etc.):

Does your child have any conditions that may make them particularly vulnerable to COVID-19 such as asthma, a heart condition or diabetes?

Please list all current medications, including over-the-counter medications:

It is expected that your child arrive for camp prepared to spend the day outdoors. This includes wearing sunscreen. If your child arrives without sunscreen, is it OK for a staff member to provide/assist with sunscreen application?

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Other Comments?

"I certify that my child will have health insurance coverage during camp, and I give full consent for my child to receive the medical treatment deemed necessary by those responsible."

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Reasonable attempts will be made to inform legal guardians in case medical treatment is required.

Insurance Company

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Policy / Group/ ID Number(s)

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Photo Release

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I agree that any photographs or digital images taken by Columbia Springs personnel of my child as a program participant, and copies of artwork made by my child while a Columbia Springs program participant, shall be the property of Columbia Springs, and may be used by Columbia Springs, at its discretion, for any publicity, education, marketing and/or advertising purposes. I hereby consent to and authorize such use without restriction.

Would you like to be added to the Columbia Springs' mailing list?

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How did you very first hear about our Summer Nature Camp?

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Please tell us how you heard about camp!

Payment

You will be redirected to a payment page after submitting this form.

Confirm registration *	Quantity
$180 - Nature Day Camp

Confirm Camp Session:	Quantity
$180 - Session 2: July 20th-24th