Summer Camp for the Lagoon! Application Form

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Environmental Science Camp for incoming 6th-9th Graders
This is a 10 day camp Monday-Friday, at the Audubon House; 195 Oslo Rd, Vero Beach.
9 am - 3:30 pm (snacks are provided, lunch is not)
Only 12 Campers max.
$200 Camp fee paid to Pelican Island Audubon Society

July 8th - 19th, 9am-3:30pm, M-F

Questions? Email Alexis with IRC Stormwater at aperalta@indianriver.gov

Email *

Camper's Full Name: *

Which School are you attending Fall 2024: *

Which Grade Level (Entering) *

Sixth Grade (6)

Seventh Grade (7)

Eighth Grade (8)

Ninth Grade (9)

Other:

Camper's Gender *

Male

Female

Other:

Required

Please state any medical conditions, medicines that will be brought to camp, or allergies (along with the severity of the allergy): *

Parent(s) Name: *

Full Address:

Phone Number(s): *

Emergency Contact if Parent(s) unavailable:

Please include a name and phone numbers

Adult(s) authorized to pick up child:

T-shirt Size (Unisex Adult)

XXL

Clear selection

Please tell why you would like to participate in this summer camp.

Is the student an Audubon Advocate graduate?

Yes

Clear selection

You will be notified by return email if your child has been accepted and will have 7 days to make payment ($200); failure to pay in time will remove your child from camp registration due to high demand. Please call 772-567-3520 for any questions.

Send me a copy of my responses.

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