Summer 2025 HPEC Camp

Nature Rangers Summer Camp 2025

at High Plains Environmental Center
Child Information
Child's Name*

First NameLast Name
Age*
Gender*

MaleFemaleOther
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Please include info about inhalers and medications.
Is there any other information that you would like to share with us about your child?
Ex: Any medical, learning, behavioral, or emotional challenges that may affect how we cater our teaching style to your child? How does your child interact with other children, adults?
Is there a particular learning style that best fits your child?
What do you hope for your child to gain or experience by attending?
Parent Information
Parent/ Guardian Name*

First NameLast Name
Relationship*
Phone Number

Area CodePhone Number
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Information

This is a good opportunity to provide a secondary contact in the event that you are unavailable, if you wish.
Emergency Contact Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
How did you hear about Rugged Research?*

ReturningFriendFacebookInstagramYoutubeWeb/Google searchMacaroni KidsOther
Select your program!

Each session will run on a M-F schedule from 9:00am - 1:00pm for a total of 5 days
Program Selection*
Payment
Sibling Discount: If you are enrolling siblings in the same course, please enter the siblings name in the box below and enter Sib5 in the Promo Code area below for a 5% sibling discount.
Sibling's Name

Payment*

HPEC Nature Rangers Camp$250.00

Enter coupon

Subtotal $0.00Tax $0.00Total $0.00

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

Please note that in the event Rugged Research issues you a refund for your payment, the Third Party Processing fee is not refundable.
Confirmation

BY AGREEING AND ENTERING MY NAME BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Name of Parent/Guardian:*

First NameLast Name
Date*

MonthDayYear
Date
Please verify that you are human*
Please close your browser after submitting to prevent double submissions/ payments. Thanks!
Should be Empty:

Nature Rangers Summer Camp 2025