Registration: CWC Summer Camp 2022

Summer Camp Registration Form

Please complete the form below to register your child for our summer programs.

Camper Information
Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade Level *
Any allergies? *

No known allergies List allergies here
Any activity the camper should be restricted from?
Any physical, cognitive or other condition that would require special attention or medication while at camp?

Parent/Legal Guardian Information
Parent/Legal Guardian *

First Name Last Name
Relation *
Email Address *
example@example.com
Cell/Home Phone *
Work Phone
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Additional Parent/Legal Guardian (optional)
Parent /Legal Guardian 2
Relation 2
Email Address 2
example@example.com
Cell/Home Phone 2
Work Phone 2

Additional Emergency Contact
Emergency Contact Name (if parent or guardian is not available) *
Emergency Contact Relation
Emergency Number *
Emergency Number #2

Pick-up/Drop-off Authorization
Please list the names of ALL individuals who are authorized to pick-up your camper (including parents/guardians and emergency contacts entered above). *

Camper Photo/Media Release
I agree that photos of my child can be taken and used in marketing materials. *

Yes No

Camp Selection & Payment

June 20 - 24: Wild About Wetlands 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 7-9.

$ 250.00

June 27 - July 1: Ecosystem Investigators 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 9-11.

$ 250.00

July 11 - 15: Take Flight! 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 7-9.

$ 250.00

July 18 - 22: Junior Biologists 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 9-11.

$ 250.00

July 25 - 29: Buggin' Out! 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 7-9.

$ 250.00

August 1 - 5: Junior Wildlife Rehabbers 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 9-11.

$ 250.00

August 8 - 12: Reptiles & Amphibians 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 7-9.

$ 250.00

August 15 - 19: Wilderness 101 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 9-11.

$ 250.00

August 22 - 26: Forest Explorers 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 7-9.

$ 250.00

August 29 - Sept 2: Wilderness 101 (Repeat session due to popular demand!) 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 9-11.

$ 250.00

Chintimini Camp T-shirt

$ 15.00 T-Shirt Quantity

Enter coupon

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

How did you hear about Chintimini Wildlife camps? *

Terms & Conditions
Date & Time of Registration

Month Day Year
Hour Minutes AM/PM Option
Should be Empty:

Summer Camp Registration Form