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 NameLast Name
Date of Birth*

MonthDayYear
Grade Level*
Any allergies?*

No known allergiesList 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 NameLast Name
Relation*
Email Address*
example@example.com
Cell/Home Phone*
Work Phone
Address*

Street Address

Street Address Line 2

CityState / 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.*

YesNo

Camp Selection & Payment

June 19 - 23: Wild About Wetlands! Product Image

June 19 - 23: Wild About Wetlands! 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 6-9.

$300.00

June 26 - 30: Junior Biologist Product Image

June 26 - 30: Junior Biologist 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 10-12

$300.00

July 10-14 :Buggin' Out! 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 10-12

$300.00

July 17-21: Take Flight9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 10-12

$300.00

July 24-28: Reptiles & Amphibians Product Image

July 24-28: Reptiles & Amphibians9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 6-9.

$300.00

July 31- Aug 4: Junior Wildlife Rehabbers Product Image

July 31- Aug 4: Junior Wildlife Rehabbers9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 10-12.

$300.00

Aug 7-11: Take Flight9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 6-9.

$300.00

Aug 21-25: Wilderness 101(Repeat session due to popular demand!) 9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 10-12.

$300.00

Aug 28 -Sept 1: Forest Explorers Product Image

Aug 28 -Sept 1: Forest Explorers9am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 6-9.

$300.00

Sept 4-8: Wilderness 1019am-3pm (postcare available between 3 -5:15pm @ $15/day). Appropriate for ages 10-12.

$300.00

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

MonthDayYear
Hour MinutesAM/PM Option
Should be Empty:

Summer Camp Registration Form