2022 Peace Camper Registration Form
Peace Camp For Kids 2023

When: June 20 to June 24, 2022 -- 9 AM to 3 PM daily

Who: Children entering kindergarten through eighth grade in September 2022 are eligible for Peace Camp 2022

Fees: $125.00 per child

Scholarships available--please email peacecamp@peaceandjusticecenter.com and ask!

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Email *
Child #1 full name *
Child #1 date of birth *
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Child #1 most recent grade completed *
Child #2 full name
Child #2 date of birth
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DD
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YYYY
Child #2 most recent grade completed
Child #3 full name
Child #3 date of birth
MM
/
DD
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YYYY
Child #3 most recent grade completed
Parent or guardian name *
Parent or guardian phone *
Parent or guardian home address *
Emergency contact name *
Emergency contact phone number *
Emergency contact e-mail address *
Emergency contact relation to child(ren) *
Please explain health care, dietary, or any other information about your child that you feel we should be aware of:
Photography permission: "I do hereby release and hold harmless The Peace and Justice Center, its officers, and employees from any claims." *
Required
By submitting this document, I acknowledge that I have read it in its entirety, that I understand its contents, meaning, and effect, and that I have agreed to its terms completely and voluntarily. I also acknowledge by submitting this application that I accept the allocation of risks and responsibility as between Peace Camp and myself set forth in this agreement. The Peace and Justice Center is relying on my consent to the terms of this agreement in its operation generally and in allowing my child(ren), in particular, to attend.
A copy of your responses will be emailed to the address you provided.
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