Little Adventures Summer Nature Camp Registration
In order to register your child, please fill out the entire form. Please complete one form for each participant.  
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Email *
Is anyone in your household a member of Cope Environmental Center?
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Child's First & Last Name *
Date of Birth *
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Registration Week *
Required
Dietary Restrictions *
List all known allergies. Describe reaction and management of the reaction.
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Will the camper need to take any medication while at CEC camp? If yes, list medication & dosage.
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Any additional medical or behavioral issues CEC staff should know about:
Home Address
Street Address
City, State, Zip
*
Parent/Guardian First & Last Name *
Parent/Guardian Phone Number *
Emergency Contact Name (if we can not reach you) *
Emergency Contact Phone Number *
2nd Emergency Contact Name *
2nd Emergency Contact Phone Number *
Names of others picking up your child from camp
  Potty Training Acknowledgment:   (Please initial)

I confirm that my child is fully potty trained and able to use the restroom independently. I understand that this is a requirement for participation in the program.
*
Waivers:
A. Your signature below indicates your consent for Cope Environmental Center to use any photograph,
picture or likeness of your child for promotional purposes.
B. I hereby give my permission to Cope Environmental Center to seek medical treatment for my child
while attending camp. I also authorize staff to administer First Aid, or transport my child to a medical facility, if the need arises.
C. If a Cope Environmental Center staff member is to administer any prescription drugs to my child while
there, the prescription will be in the original bottle with the name of the medication, the dosage, and the frequency of administration & note with time of last dose.
D. My child’s health history is correct and complete as for as I know, and my child, as described, has permission to engage in all camp activities except as noted. If there is something not included on the form, please attach an explanation or contact CEC staff.
*
I understand and accept the refund policy. (Please initial) There are no refunds for cancellations within 30 days from the desired camp date.  A $25 cancellation fee will be deducted from registration fee for any cancellation greater than 30 days before a camp’s start date and the remaining balance will be refunded.  If a camp is cancelled, you will be notified as soon as possible.  Refunds will not be given for absent or sick days. Exceptions granted only in the case of a health emergency, evidenced by a written physician’s statement, restricting the child from attending camp  or the entire session. *
Pick-Up Policy (Please initial)

Pick-Up Time:
Camp concludes at 12:00 PM each day. All children must be picked up by this time.

Grace Period:
We understand that unforeseen delays can occur, so we offer a 10-minute grace period for the first late pick-up incident. After 12:10 PM, a $10 late fee will apply for every 10 minutes or part thereof.

Late Pick-Up Fees:
Only one grace period will be granted per family. For subsequent late pick-ups, the following fees will apply:

$10 for every 10 minutes (or part thereof) after 4:30 PM.

I understand and agree to the pick-up policy. 
*
Within 5 days of your registration, an invoice will be sent to you via email or text. You can pay the invoice using the link provided in the email or text, or you may choose to send a check to Cope Environmental Center. Please do not submit payment for camp fees directly through our website. The invoice will include a discounted rate for siblings, as applicable.  (Please initial)

To register multiple children within the same household please complete a new registration form for each child.
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