Knox-Lincoln Soil & Water Conservation District · Summer Ecology Camps Registration Form

Parent/Guardian Contact Information

Please provide name, email, phone, and address for at least one and up to two parent(s)/guardian(s).

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Email *

Verify Email *

Parent/Guardian Phone *

Parent/Guardian Phone Type *

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Parent/Guardian #2 Name

First Name

Last Name

Parent/Guardian #2 Email

Verify Email

Parent/Guardian #2 Phone

Parent/Guardian #2 Phone Type

Parent/Guardian #2 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Who has permission to pick up your child(ren) from camp? List the name and phone number of each individual. *

Be sure to update this information throughout camp if necessary. Include first and last name and phone number of the individual(s). Provide any other additional necessary details.

Emergency Contact(s)

Please provide at least one emergency contact for your child(ren)

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

Emergency Contact Relation to Participant(s) *

Would you like to add an additional emergency contact?

Yes

No

Emergency Contact #2 Name *

First Name

Last Name

Emergency Contact #2 Phone *

Emergency Contact #2 Relation to Participant(s) *

Child Information

Please provide important information about your child

Child Name *

First Name

Last Name

Child Date of Birth *

(mm/dd/yyyy)

Child Grade (Fall 2024) *

Camp Registration: Select Little Sprouts if your child was born between July 9, 2017 - July 8, 2020 (4 through 6-year-olds). Select Eco-Explorers if your child was born between June 25, 2014 - June 24, 2017 (7 through 9-year-olds). *

If your child is turning 7 between June 25-July 8, 2024 (born between June 25, 2017-July 8, 2017), then they are between camps. Choose whichever camp you think will be more appropriate for your child.

Little Sprouts, Ages 4-6 (Camp Dates: July 8-12, 2024) FULL - submit this form to join waitlist.

Eco-Explorers, Ages 7-9 (Camp Dates: June 24-28, 2024) FULL - submit this form to join waitlist.

Does your child have any serious allergies? *

During Ecology Camp, children may come into contact with potential allergens, including insect stings, poisonous plants, and foods (peanuts, tree nuts, etc.). If your child is allergic to any drugs that may be issued in case of emergency, please list those as well. Write N/A if not applicable.

Are there any special conditions that would make your child unable to participate in active, outdoor activities, or any other special considerations you would like to make known to Merryspring and Knox-Lincoln SWCD staff? *

Write N/A if not applicable

Is the child taking any prescribed medication? Write N/A if not applicable. *

If so, please tell us the drug, the condition under which it is taken, and the frequency. Merryspring and Knox-Lincoln SWCD staff cannot administer prescription medication to children unless in emergency, such as an allergic reaction. Please make sure to notify us in writing of any changes in this area between the time you fill out this sheet and the time the child arrives here for camp.

Child's Physician Name *

Child's Physician Phone Number *

What was the date of your child's most recent tetanus booster? *

Please download, complete, and sign the Release & Assumption of Risk form, then upload it below:

Release & Assumption of Risk and Photo Release *

Download and complete the form using the link above, and upload here.

Additional Child(ren)

Fill out registration information for any additional children you are registering

Would you like to register an additional child or children? *

No, I am registering only one child

Yes, I would like to register one additional child

Yes, I would like to register two additional children

Yes, I would like to register three additional children

Child #2 Name *

First Name

Last Name

Child #2 Date of Birth *

(mm/dd/yyyy)

Child #2 Grade (Fall 2024) *

Child #2 Camp Registration: Select Little Sprouts if Child #2 was born between July 13, 2017 - July 8, 2020 (4 through 6-year-olds). Select Eco-Explorers if Child #2 was born between June 25, 2015 - June 24, 2017 (7 through 9-year-olds). *

If Child #2 is turning 7 between June 25-July 12, 2024 (born between June 25, 2017-July 12, 2017), then they are between camps. Choose whichever camp you think will be more appropriate for your child.

Little Sprouts, Ages 4-6 (Camp Dates: July 8-12, 2024)

Eco-Explorers, Ages 7-9 (Camp Dates: June 24-28, 2024)

Does Child #2 have any serious allergies? *

During Ecology Camp, children may come into contact with potential allergens, including insect stings, poisonous plants, and foods (peanuts, tree nuts, etc.). If your child is allergic to any drugs that may be issued in case of emergency, please list those as well. Write N/A if not applicable.

Are there any special conditions that would make Child #2 unable to participate in active, outdoor activities, or any other special considerations you would like to make known to Merryspring and Knox-Lincoln SWCD staff? *

Write N/A if not applicable.

Is Child #2 taking any prescribed medication? Write N/A if not applicable. *

If so, please tell us the drug, the condition under which it is taken, and the frequency. Merryspring and Knox-Lincoln SWCD staff cannot administer prescription medication to children unless in emergency, such as an allergic reaction. Please make sure to notify us in writing of any changes in this area between the time you fill out this sheet and the time the child arrives here for camp.

Child #2's Physician Name

Only need to fill out if different from another child's physician.

Child #2's Physician Phone Number

Only need to fill out if different from first child's physician.

What was the date of Child #2's most recent tetanus booster? *

Please download, complete, and sign the Release & Assumption of Risk form for Child #2, then upload it below:

Child #2 Release & Assumption of Risk and Photo Release *

Download and complete the form using the link above, and upload here.

Child #3 Name *

First Name

Last Name

Child #3 Date of Birth *

(mm/dd/yyyy)

Child #3 Grade (Fall 2024) *

Child #3 Camp Registration: Select Little Sprouts if Child #3 was born between July 13, 2017 - July 8, 2020 (4 through 6-year-olds). Select Eco-Explorers if Child #3 was born between June 25, 2015 - June 24, 2017 (7 through 9-year-olds). *

If Child #3 is turning 7 between June 25-July 12, 2024 (born between June 25, 2017-July 12, 2017), then they are between camps. Choose whichever camp you think will be more appropriate for your child.

Little Sprouts, Ages 4-6 (Camp Dates: July 8-12, 2024)

Eco-Explorers, Ages 7-9 (Camp Dates: June 24-28, 2024)

Does Child #3 have any serious allergies? *

During Ecology Camp, children may come into contact with potential allergens, including insect stings, poisonous plants, and foods (peanuts, tree nuts, etc.). If your child is allergic to any drugs that may be issued in case of emergency, please list those as well. Write N/A if not applicable.

Are there any special conditions that would make Child #3 unable to participate in active, outdoor activities, or any other special considerations you would like to make known to Merryspring and Knox-Lincoln SWCD staff? *

Write N/A if not applicable.

Is Child #3 taking any prescribed medication? Write N/A if not applicable. *

If so, please tell us the drug, the condition under which it is taken, and the frequency. Merryspring and Knox-Lincoln SWCD staff cannot administer prescription medication to children unless in emergency, such as an allergic reaction. Please make sure to notify us in writing of any changes in this area between the time you fill out this sheet and the time the child arrives here for camp.

Child #3's Physician Name

Only need to fill out if different from another child's physician.

Child #3's Physician Phone Number

Only need to fill out if different from another child's physician

What was the date of Child #3's most recent tetanus booster? *

Please download, complete, and sign the Release & Assumption of Risk form for Child #3, then upload it below:

Child #3 Release & Assumption of Risk and Photo Release *

Download and complete the form using the link above, and upload here.

Child #4 Name *

First Name

Last Name

Child #4 Date of Birth *

(mm/dd/yyyy)

Child #4 Grade (Fall 2024) *

Child #4 Camp Registration: Select Little Sprouts if Child #4 was born between July 13, 2017 - July 8, 2020 (4 through 6-year-olds). Select Eco-Explorers if Child #4 was born between June 25, 2015 - June 24, 2017 (7 through 9-year-olds). *

If Child #4 is turning 7 between June 25-July 12, 2024 (born between June 25, 2017-July 12, 2017), then they are between camps. Choose whichever camp you think will be more appropriate for your child.

Little Sprouts, Ages 4-6 (Camp Dates: July 8-12, 2024)

Eco-Explorers, Ages 7-9 (Camp Dates: June 24-28, 2024)

Does Child #4 have any serious allergies? *

During Ecology Camp, children may come into contact with potential allergens, including insect stings, poisonous plants, and foods (peanuts, tree nuts, etc.). If your child is allergic to any drugs that may be issued in case of emergency, please list those as well. Write N/A if not applicable.

Are there any special conditions that would make Child #4 unable to participate in active, outdoor activities, or any other special considerations you would like to make known to Merryspring and Knox-Lincoln SWCD staff? *

Write N/A if not applicable.

Is Child #4 taking any prescribed medication? Write N/A if not applicable. *

If so, please tell us the drug, the condition under which it is taken, and the frequency. Merryspring and Knox-Lincoln SWCD staff cannot administer prescription medication to children unless in emergency, such as an allergic reaction. Please make sure to notify us in writing of any changes in this area between the time you fill out this sheet and the time the child arrives here for camp.

Child #4's Physician Name

Only need to fill out if different from another child's physician.

Child #4's Physician Phone Number

Only need to fill out if different from another child's physician

What was the date of Child #4's most recent tetanus booster? *

Please download, complete, and sign the Release & Assumption of Risk form for Child #4, then upload it below:

Child #4 Release & Assumption of Risk and Photo Release *

Download and complete the form using the link above, and upload here.

Summer Ecology Camps Registration Form

To register your child(ren) for Summer Ecology Camps, complete the online registration form below.

Parent/Guardian Contact Information

Emergency Contact(s)

Child Information

Please download, complete, and sign the Release & Assumption of Risk form, then upload it below:

Additional Child(ren)

Please download, complete, and sign the Release & Assumption of Risk form for Child #2, then upload it below:

Please download, complete, and sign the Release & Assumption of Risk form for Child #3, then upload it below:

Please download, complete, and sign the Release & Assumption of Risk form for Child #4, then upload it below: