EcoStars Summer Camp Online Registration Form

Camper Information

Camper's Name:*
Camper's Address:*
Phone Number of Parent/Guardian:*
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Alternate Phone Number for Parent/Guardian:
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Parent/Guardian's E-mail:
Camper's Health Card Number:*
Age of Camper:*
Camper Shirt Size (Child Sizing):*
Who will be picking the Camper up?:*
Relationship of Pick-Up Person to Camper:*
Does the Camper have any allergies? Please list:
Does the Camper use/carry an Epi-Pen?:
Does the Camper have any dietary restrictions? Please list:
Any additional medical concerns that we should be aware of? Please lst:
Any developmental/learning concerns?:
Emergency Contact #1:*
Emergency Contact #1 Relationship to Camper:*
Emergency Contact #1 Phone Number:*
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Emergency Contact #2:*
Emergency Contact #2 Relationship to Camper:*
Emergency Contact #2 Phone Number:*
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Photo Release: Photos are taken throughout the camp week and are often used (without names) for future promotional purposes. If you are comfortable having your child’s picture taken, please select “yes” in the check box below:*
Waiver: By clicking below, I hereby release Green Venture from all claims or damages arising from participation of the applicant hereon during any program or in any location where a program is held (i.e. field trips, etc), except where such damage or injury results from the gross negligence of Green Venture and/or its employees.*
I have read and agreed to: the Cancellation Policy, Code of Conduct, and the Camp Discipline Policy.*
How did you hear about EcoStars Summer Camp?:
Other:

Registration and Payment Information

I would like to register for the following:

Camp Sessions:*