One moment please...
Waterman Summer Camp Wk 3 2021 Application
Waterman Summer Camp Week 3- July 19-23, 2021
Camp Age
*
Please select how old your child will be when they come to camp.
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
Camper Information
Camper Name
*
First Name
Last Name
Date
*
Camper Date of Birth
Sex
*
Male
Female
Parent's Information
Phone
Mother's Information
*
First Name
Last Name
Father's Information
*
First Name
Last Name
Email
Verify Email
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Mother's Employment Information is Required and Will Be Kept Strictly Confidential
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Father's Employment Information is Required and Will Be Kept Strictly Confidential Copy
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Mother's Work Phone
Father's Work Phone
Person/s Authorized to pick up camper
*
First Name
Last Name
Relationship to child
*
Person/s Authorized to pick up camper
First Name
Last Name
Relationship to child
Person/s Authorized to pick up camper
First Name
Last Name
Relationship to child
Person/s Authorized to pick up camper
First Name
Last Name
Relationship to child
Health Care Provider/Insurance
*
Please provide-Physician Phone Number, Preferred Hospital and Insurance Company
Medical Information
Allergies
*
Allergies: (please write "none" if no allergies)
Medications
*
Medications: (list with doses and times, or write "none" if no medications)
Medical or Behavioral Conditions
*
Medical/ Behavioral Conditions: (please list "none," if no conditions)
Terms and Conditions
*
I give my permission for my child to participate in the Summer Camp Program at Waterman Conservation Education Center. This child, to the best of my knowledge, is in good physical condition and is capable of hiking the trails and other planned outdoor activities. I understand that hiking and other activities associated with an outdoor camp have an inherent risk factor, and that all appropriate precautions will be taken for the safety of my child. I give permission to the Waterman Center staff, volunteers and /or medical staff to administer proper medical assistance to the named above participant if needed. I agree not to hold the Fred L. Waterman Conservation Education Center, Inc. or any of their agents responsible in the event of injury to my child. In addition, I authorize the verification of the information provided on this form. I grant permission for video recordings and digital photographs to be taken of my child or my child’s work as part of her/his participation in the Waterman Conservation Education Center Nature Camp. I authorize the Waterman Conservation Education Center to use my child’s image for websites and/or in printed promotional materials without further consideration and I acknowledge Waterman Conservation Education Center’s right to treat the media (such as cropping) at its discretion. I understand that once my child’s image is posted on the Waterman Conservation Education Center’s website, the image could possibly be downloaded by a third party. I agree that I will not hold Waterman Conservation Education Center responsible for any harm that may arise from such unauthorized reproduction.
I agree
Discipline Policy
*
Waterman Center and our Camp Program Director work hard to ensure the safety and happiness of our campers. If a child manifests poor behavioral decisions we will make every effort to resolve the problem. In the event, the behavior persists or worsens, expulsion may be warranted for the good of the other campers. Reasons for expulsion include but are not limited to, physical violence of any kind, biting, inappropriate language, inappropriate touching, bullying, abusive behavior, tantrums, and/or angry outbursts, campers not following Covid-19 infection control and safety procedures. Expulsion does not qualify for a refund. All discipline decisions will be at the discretion of the Camp Program Director.
I agree
Sunscreen/Bug spray Policy
*
Use of Sunscreen/bug spray: I give permission for my child to carry and self-apply sunscreen/bug spray. The sunscreen will only be used to prevent overexposure of the sun. The bug spray will only be used to reduce the possibility of bug bites. Only sunscreen and bug spray approved by the FDA for over the counter use will be permitted for use by the child. Reminder: Sunscreen and bug spray are considered a drug and shall be checked and logged by Waterman Conservation Education Center staff. Furthermore, Waterman Conservation Education Center staff will not be able to aide in application of sunscreen or bug spray.
I agree
File Upload
*
Please attach current health records as well as immunization records for your child.
Inhaler
*
My child is independent in the use of his/her inhaler. My child does not need assistance in its use. The inhaler will be kept with my child’s counselor during camp hours.
I agree
My child does not use an inhaler
Covid-19 Waiver
*
I acknowledge that the novel coronavirus (“COVID-19”) is a global pandemic and that infections have been confirmed throughout the United States and Internationally, including in New York State. I understand that Waterman Conservation Education Center cannot guarantee my safety or immunity from infection. With this understanding, I knowingly and voluntarily waive and release Waterman Conservation Education Center and their employees from any and all present and future claims of any type, including for any harm or loss, economic loss, personal injury, disease, or death.
I agree
Acknowledge Form
*
In checking that "I agree", I certify my understanding of this form and agree to instruct my child to abide by all the instructions given to my child by Waterman Conservation Education Center volunteers, employees, or agents during my child’s stay at camp. I also acknowledge that all information has been filled out to the best of my ability and knowledge.
I agree
Camp Deposit
*
This year, in order to reserve your child/ren’s spot at camp, a cash or check deposit of $25 per child is required. Please submit deposit by June 1st or ASAP to secure your child/ren's camp spot. Please mail or drop off the check at Waterman Conservation Education Center, 403 Hilton Rd, Apalachin, NY 13732. Facility is open Monday- Friday 9am-4pm.
I will mail my deposit.
I will drop off my deposit at the center.