PEBC Summer Camp Registration Form
Camper's Name
*
First Name
Last Name
Birth Date
Please select a month
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Year
Grade in 2024-2025 School Year:
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.
*
Yes
No
Allergies/Health Concerns:
*
Are you applying for a scholarship?
Yes
No
Will your camper need to ride the free UCAP bus to and/or from camp? (contingent on availability)
Yes
No
UCAP Pick Up Address
UCAP Drop Off Address
How did you hear about Camp?
Please Select
Email
Social Media
JCC Community Ed Catalog
Other People
Website
Will you be paying online today?
Yes
No
Which camps would your child like to attend?
PreK Oh, the Nature You'll See!
K-2 Digging with Dinosaurs
K-2 Nature Olympics
K-3 Whose Scat is That?
3-5 Prairie Survival
3-5 Get Your Game On!
3-5 Earthly Elements
4-6 Galactic Travelers
6-8 Camper Led
Garden Club
Would you like to preorder a Camp T-shirt for an additional cost of $12?
Yes
No
T-Shirt Size (Youth Extra Small - Adult 2XL)
Would you like to preorder a Summer Camp Canvas Drawstring Backpack for an additional cost of $10?
Yes
No
Would you like personalize this backpack for an extra $2? If so, type what you would like below:
Add Another Child?
Yes
Back
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Camper's Name
*
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
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10
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12
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14
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2006
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.
*
Yes
No
Allergies/Health Concerns:
*
Will your camper need to ride the free UCAP bus to and/or from camp? (contingent on availability)
Yes
No
UCAP Pick Up Address
UCAP Drop Off Address
Which camps would your child like to attend?
PreK Oh, the Nature You'll See!
K-2 Digging with Dinosaurs
K-2 Nature Olympics
K-3 Whose Scat is That?
3-5 Prairie Survival
3-5 Get Your Game On!
3-5 Earthly Elements
4-6 Galactic Travelers
6-8 Camper Led
Garden Club
Would you like to preorder a Camp T-shirt for an additional cost of $12?
Yes
No
T-Shirt Size (Youth Extra Small - Adult 2XL)
Would you like to preorder a Summer Camp Canvas Drawstring Backpack for an additional cost of $10?
Yes
No
Would you like personalize this backpack for an extra $2? If so, type what you would like below:
Add Another Child?
Yes
Back
Next
Camper's Name
*
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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2002
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1990
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1984
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1982
1981
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1978
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1952
1951
1950
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1948
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1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.
*
Yes
No
Allergies/Health Concerns:
*
Will your camper need to ride the free UCAP bus to and/or from camp? (contingent on availability)
Yes
No
UCAP Pick Up Address
UCAP Drop Off Address
Which camps would your child like to attend?
PreK Oh, the Nature You'll See!
K-2 Digging with Dinosaurs
K-2 Nature Olympics
K-3 Whose Scat is That?
3-5 Prairie Survival
3-5 Get Your Game On!
3-5 Earthly Elements
4-6 Galactic Travelers
6-8 Camper Led
Garden Club
Would you like to preorder a Camp T-shirt for an additional cost of $12?
Yes
No
T-Shirt Size (Youth Extra Small - Adult 2XL)
Would you like to preorder a Summer Camp Canvas Drawstring Backpack for an additional cost of $10?
Yes
No
Would you like personalize this backpack for an extra $2? If so, type what you would like below:
Add Another Child?
Yes
Back
Next
Camper's Name
*
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.
*
Yes
No
Allergies/Health Concerns:
*
Will your camper need to ride the free UCAP bus to and/or from camp? (contingent on availability)
Yes
No
UCAP Pick Up Address
UCAP Drop Off Address
Which camps would your child like to attend?
PreK Oh, the Nature You'll See!
K-2 Digging with Dinosaurs
K-2 Nature Olympics
K-3 Whose Scat is That?
3-5 Prairie Survival
3-5 Get Your Game On!
3-5 Earthly Elements
4-6 Galactic Travelers
6-8 Camper Led
Garden Club
Would you like to preorder a Camp T-shirt for an additional cost of $12?
Yes
No
T-Shirt Size (Youth Extra Small - Adult 2XL)
Would you like to preorder a Summer Camp Canvas Drawstring Backpack for an additional cost of $10?
Yes
No
Would you like personalize this backpack for an extra $2? If so, type what you would like below:
Add Another Child?
Yes
Back
Next
Camper's Name
*
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
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1959
1958
1957
1956
1955
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1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.
*
Yes
No
Allergies/Health Concerns:
*
Will your camper need to ride the free UCAP bus to and/or from camp? (contingent on availability)
Yes
No
UCAP Pick Up Address
UCAP Drop Off Address
Which camps would your child like to attend?
PreK Oh, the Nature You'll See!
K-2 Digging with Dinosaurs
K-2 Nature Olympics
K-3 Whose Scat is That?
3-5 Prairie Survival
3-5 Get Your Game On!
3-5 Earthly Elements
4-6 Galactic Travelers
6-8 Camper Led
Garden Club
Would you like to preorder a Camp T-shirt for an additional cost of $12?
Yes
No
T-Shirt Size (Youth Extra Small - Adult 2XL)
Would you like to preorder a Summer Camp Canvas Drawstring Backpack for an additional cost of $10?
Yes
No
Would you like personalize this backpack for an extra $2? If so, type what you would like below:
Back
Next
Family Information
Parent/Guardian's Name
*
First Name
Last Name
Contact Phone Number
*
E-mail Address
*
example@example.com
Back
Next
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Relationship to Camper
*
Back
Next
Have you ever received a scholarship to PEBC camps before?
Yes
No
When?
How did you hear about our scholarship program?
Please select if your child is a part of these groups.
Big Buddies
Heron Lake Caring Connections
How would your child benefit from being at a PEBC camp? What nature/science interest/experience has your child had (in school, at home, or other programs)?
Is your child eligible for free or reduced lunch?
Yes
No
Please list any financial circumstances that you would like to have considered as a basis for awarding this scholarship.
Is there anything else you would like for us to know?
Back
Next
Payment
My Products
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Garden Club
$
120.00
Quantity
1
2
3
4
5
6
7
8
9
10
PreK - Oh, the Nature You'll See!
June 11th-13th, 9:00 a.m. to noon
$
70.00
Quantity
K-2 - Digging with Dinosaurs
July 16th-19th, 9:00 a.m. to noon
$
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
K-2 Nature Olympics
July 29th-30th, 9:00 a.m. to noon
$
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
K-3 - Whose Scat is That?
July 2nd, 9:00 a.m. to 1:00 p.m.
$
45.00
Quantity
1
2
3
4
5
6
7
8
9
10
3-5 Prairie Survival
June 18th-21st, 9:00 a.m. to 1:00 p.m.
$
90.00
Quantity
1
2
3
4
5
6
7
8
9
10
3-5 Get Your Game On!
July 10th-11th, 9:00 a.m. to 2:00 p.m.
$
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
3-5 Earthly Elements
August 6th-7th, 9:00 a.m. to 2 p.m.
$
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
4-6 Galactic Travelers
August 13th-15th, 9:00 a.m. to noon
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
6-8 Camper Led
August 21st-22nd, 9:00 a.m. to 3:00 p.m.
$
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Summer Camp T-Shirt
$
12.00
Quantity
Youth Extra Small
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Youth Small
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Youth Medium
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Youth Large
1
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Adult Small
1
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Adult Medium
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Adult Large
1
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Adult Extra Large
1
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15
Adult 2XL
1
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15
Summer Camp Canvas Drawstring Backpack
If you would like your bag personalized, please fill out the personalization field below the checkout!
$
10.00
Quantity
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2
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4
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6
7
8
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10
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