Columbia Springs · 2024 Summer Nature Day Camp Session 3 : 6th & 7th Graders

Camper Information

Camper's Name

*

First Name

Last Name

Camper's Gender:

*

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

*

Camper's Date of Birth

*

(mm/dd/yyyy)

What school does this camper attend?

*

Does your child have a friend or sibling they would like to attend camp with?

(Cabin groups are composed of similarly aged campers)

Camper tee-shirt size

*

Contact Information

Guardian's Name

*

First Name

Last Name

Relationship to Camper:

*

Email

*

Verify Email

*

Cell Phone

*

Additional Phone (Home)

Not necessary if same as number above.

Additional Phone (Work)

Not necessary if same as number above.

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Are you (the guardian) the primary emergency contact?

*

In an emergency, the primary emergency contact is:

*

First Name

Last Name

Relationship to Camper

*

Emergency Contact's CELL number

*

Emergency Contact additional phone (home)

Not necessary if same as number above.

Emergency Contact additional phone (work)

Not necessary if same as number above.

Secondary Emergency Contact

*

First Name

Last Name

Relationship to Camper

*

Secondary Contact's CELL number

*

Secondary Contact additional phone (home)

Not necessary if same as number above.

Secondary Contact additional phone (work)

Not necessary if same as number above.

INCLUDING YOURSELF, please list the first and last name of each person authorized to pick your child up from camp. Please separate names with the return key

*

Camper Details

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

*

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?

*

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

*

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

*

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

If YES** please list food allergies below:

*

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:

How many doses of COVID -19 vaccine will your camper have received by the date two weeks prior to their first day of camp?

*

Vaccination Record

If your camper has received Covid19 vaccination please upload a copy of your camper's vaccination record here -or- bring along a copy to show at check in on the first day .

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?

*

"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."

*

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

Insurance Company

*

Policy / Group/ ID Number(s)

*

Photo Release

*

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?

*

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

*

Please tell us how you heard about camp!

We want to hear your requests! Does your camper have any favorite topics of interest or activities they would be particularly excited to explore at camp?

Is there anything else you'd like us to know?

Payment

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

Session 3: 6th & 7th graders	Quantity
$185 - Summer Nature Day Camp