Summer Nature Camp Registration

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In order to register your child, please fill out the entire form. Please complete one form for each participant.

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Διεύθυνση ηλεκτρονικού ταχυδρομείου *

Is anyone in your household a member of Cope Environmental Center?

Yes

Διαγραφή επιλογής

Child's First & Last Name *

Grade Level for 2024-25 school year *

Date of Birth *

ΜΜ

ΗΗ

ΕΕΕΕ

Select camp week(s) Register for all four and receive a free camp t-shirt *

Week 1 June 3-7

Week 2 June 10-14

Week 3 June 17-21

Week 4 June 24-28

Υποχρεωτική

Dietary Restrictions *

List all known allergies. Describe reaction and management of the reaction.
*

Will the camper need to take any medication while at CEC camp? If yes, list medication & dosage.
*

Any additional medical or behavioral issues CEC staff should know about:

Home Address *

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

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. *

Camp T-Shirt $15

To purchase a camp T-shirt select size. Register for all 4 weeks and receive a free T-shirt (select size)

I understand my child's camp registration is not complete until payment has been received. (Please initial)

Payment Invoice with online payment option will be emailed within 3 business days.

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

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