Camp Seven Ponds! Medical Information/Emergency Information

Camp Seven Ponds! Emergency Information

First Name *

Last Name *

Child's Information

Child's Name

Gender

Birth Date

Camp Seven Ponds! Session and Week

Pint-Sized Explorers Week #1

Pint-Sized Explorers Week #2

Knee-High Naturalists Week #1

Knee-High Naturalists Week #2

Young Explorers Week #1

Young Explorers Week #2

Young Explorers Week #3

Young Explorers Week #4

Junior Naturalists

Medical Conditions or Allergies that may Impact your Child's Time at Camp Seven Ponds!

Is your child fully vaccinated for Covid-19?

Parent/Guardian's Information

Name

Primary Phone Number

Secondary Phone Number

Email Address

Additional Emergency Contact Information

Name #1

Phone #1

Name #2

Phone #2

Will Someone Besides Yourself Drop Off or Pick Up Your Child

Please List the Individual(s) that will Pick Up or Drop Off your Child.

Your child will be responsible for applying sunscreen for themselves. If there are any special instructions for your child's sunscreen application, including if they need assistance applying it, please let us know.

Sunscreen Help

I hereby release Seven Ponds Nature Center and their employees and agents from any responsibility or liability for any injuries, losses, or damages arising from the above activity.

Signature

Date