Camper Information Form 2024

Please submit one form per child.

"*" indicates required fields

Camper Information

Camper Preferred Name:*

This is the name we will put on their nametag.

First Last

Camper Pronouns:*

Examples: he/him, she/her, they/them

Camp Season*

Which camp season are you registering for?

Camper Grade:*

Select the grade they're entering in Fall 2024.

Camper Grade:*

Select their current grade.

Camper Grade:*

Select their current grade.

Camper Date of Birth:*

Camper Needs:*

Considerations or restrictions that are helpful for Dodge staff to know to ensure a positive camp experience for everyone. Examples: behavioral considerations, neurodiversity (ADHD/Autism spectrum, anxiety, etc.), mobility needs, dietary restrictions, allergies, medications, etc.

Emergency Contacts

Parent/Guardian Name:*

The first person who should be contacted if there are any questions or issues (this information is NOT transferred from your payment).

First Last

Phone:*

Backup Contact Name:

First Last

Phone:

Relationship to camper:

Additional people who may drop off or pick up my child from camp:*

Legalities

Media Permission:*

Dodge Nature Center has permission to use my child's image for Dodge's publications, social media, website, marketing, and/or advertising.

By signing this form, I understand and agree that: A) In the event of an emergency, I give permission for Dodge Nature Center (DNC) to administer first aid and/or obtain emergency medical treatment for my child. If necessary, my child will be transported by ambulance to the nearest emergency room. Any cost incurred for transportation and/or treatment will be my responsibility. B) I will be charged $25 for every 15 minutes I am late to pick up my child. C) My child will not be permitted to leave with anyone except the people designated on the camp check-in sheet or shared at drop-off. D) DNC has the right to dismiss a camper without a refund for violating the no-tolerance policy. E) I may need to provide a personal aide, at my own expense, if my child requires supervision beyond DNC's child-to-staff ratio.

Your Typed Signature:*

First Last

Your Email:*

This will be the email we use for all camp communications (aside from the payment confirmation).

Enter Email Confirm Email

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About Camps

Scholarships

Sensory-Friendly Saturday: Feathers and Fur

Saturday, Sept. 21st

Blacksmithing Basics 1 with Coal Forge (8-session Series)

Sept. 24th - Oct. 10th

Tuesdays on the Trails

Sept. 24th - Nov. 26th

Camper Information Form 2024