LENA Wild Wonders Camp Registration Form

LENA Wild Wonders Camp Registration Form
Camper
Last Name*
First Name*
Address
City
State
Zip
Pronouns
Camper's Age*

45678
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation
Cell Phone*

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Cell Phone 2

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Email Confirmation
Parents/Guardian Email *
Health Information
Does your child have allergies we should know about

YesNo
If yes, please tell us about them.
Does your child have any medical conditions we should know about?

YesNo
If yes, please tell us about them
Is there anything you'd like us to know about your child?
Camper Photo Release
We love to highlight our work. May we take photos of your child to be used for LENA social media and website purposes? We do not identify children by name. *

YesYes, but not their face (from behind, above, hands only, etc is ok)NoNot individually, but in a group is ok
Financial Policy
Lena Wild Wonders Camp Fees

Non-Refundable Registration Fee: $15.00, due at time of registration (your child will not be added to our camp list until we receive the registration fee).

Tuition: $100; $105 if paying online

Tuition is due May 15th

Cancellation Policy: If you need to cancel, you may do so by May 15th for a full refund if you have already paid. You may cancel up to June 1st for a full refund IF we are able to fill your spot and a partial refund of $50 if we are unable to fill your spot. There will be no refunds after June 8th.
Payments

-payment by check; fill in below with the weeks/amount

-online payment; scroll down and select your weeks; note there is an added $5 processing fee

NOTE: WEEK ONE IS FULL and not avaiilable at this time.
I will be sending a check for the following amount and weeks
Make your check out to The Lena Project

Mail to:

Tricia Windschitl

2917 Radcliffe Ave.

Iowa City, IA 52245
My Products (please note if paying online your payment will be listed as to The James Gang--we are a James Gang endeavor)
prevnext( X )
Registration Fee ($15) + Processing Fee ($2)$17.00

WEEK TWO Online Payment Through Stripe: Tuition ($100) + Processing Fee ($5) $105.00

WEEK THREE Online Payment Through Stripe: Tuition ($100) + Processing Fee ($5) $105.00

Total $0.00
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18.

I waive, release, and discharge The LENA Project, and its staff from all rights and claims for damages, injuries, loss of person or property which may be sustained or occur during participation in any LENA Project and LENA Earth Warriors Camp activities.

In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above, an update may be done at registration.

I certify that my child has my permission to attend camp and participate in all activites.
Signature*
Should be Empty:

LENA Wild Wonders Camp Registration Form

Camper

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Health Information

Camper Photo Release

Financial Policy