Natural Curiosity 2025 Summer Camp Registration Form
Please complete this form to confirm your spot in the program. The information you provide will help us with planning and student safety during the program. This form is required for your children to attend camp.
Participant's Information
Member ID
Participant Name
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Preferred Name
Date of Birth
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Month
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Day
Year
Date Picker Icon
Age
Camp Week Registering For?
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Please Select
Week 1 - Ages 10-12 : June 16th-20th
Week 2 - Ages 13-15 : June 23rd-27th
Please enter the week of camp you were accepted into.
Where will the participant be dropped off for camp? See the Natural Curiosity Summer Day Camp Participant Info Webpage for details about the different options.
*
Please Select
Ralph Edwards Park Playground (8:00-8:30AM)
Natural Curiosity Animas Campus (8:30-9:00AM)
Other: drop-off location will change depending on the day (please explain in tex box below)
Where will the participant be picked up for camp? See the Natural Curiosity Summer Day Camp Participant Info Webpage for details about the different options.
*
Please Select
Ralph Edwards Park Playground (3:30-4:00PM)
Natural Curiosity Animas Campus (3:00-3:30PM)
Other: pick-up location will change depending on the day (please explain in tex box below)
If you chose "other" for either drop-off or pick-up location above, please explain here.
If participant attended last year, what gear are they able to bring back to camp this year?
Backpack
Waterbottle
Sun Hat
Compass
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Parent/Guardians' Information
Parent/Guardian 1
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
example@example.com
Cell Phone
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Home Phone
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian's Work/School Name
*
Or enter N/A if not applicable
Parent's Work/School Phone
Where would you like to be reached while your child is at camp?
*
Cell Phone
Work Phone
Home Phone
Parent/Guardians' Information
Parent/Guardian 2 - Please fill in all info if the student has a 2nd Parent/Guardian
Parent/Guardian 2
First Name
Last Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Home Phone
Home Address Same as Parent/Guardian 1?
Yes
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Where would parent/guardian 2 like to be reached while your child is at camp?
Cell Phone
Work Phone
Home Phone
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Emergency Contacts/Authorized Pickup
Please include all persons who are allowed to pickup your student. We will not allow your student to leave our supervision with anyone other than those listed on this form. Consider this when arranging carpool pickups from camp. Parents cannot be listed as emergency contacts (their information should be entered above and they are included in those who are authorized to pickup the student). List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact / Authorized Pickup Person #1
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Secondary Phone Number
Relationship to Child
*
Emergency Contact / Authorized Pickup Person #2
Please enter all info below if you want to include a 2nd Emergency Contact / Authorized Pickup Person
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child
Emergency Contact / Authorized Pickup Person #3
Please enter all info below if you want to include a 3rd Emergency Contact / Authorized Pickup Person
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child
Emergency Contact / Authorized Pickup Person #4
Please enter all info below if you want to include a 4th Emergency Contact / Authorized Pickup Person
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child
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Medical / Health Information
All student medical information is kept private and only shared internally with Natural Curiosity Staff as needed. Please provide accurate, up-to-date information to help us keep your child happy, healthy, and learning!
Does your child have any food, medication or environmental allergies?
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Yes
No
Allergies? Check all that apply
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Food
Medication
Environmental
Please list and explain any allergies
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0/150
Does your child’s allergy/allergies require camp staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?
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Yes
No
Does your child have a special health or medical condition?
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Yes
No
Please explain
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0/150
Does the special health or medical condition require camp staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?
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Yes
No
Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?
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Yes
No
Please explain
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0/150
If yes, does this medication, food supplement, or medical food need to be administered at the day camp?
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Yes
No
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
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Yes
No
Please explain
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0/150
List any pertinent history of hospitalization, outpatient surgery, or previous health concerns that would be needed to assist the staff or medical personnel in an emergency situation.
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0/200
List any additional information about your child that would be useful for staff to know, such as fears, eating habits, or special routines. This information should not be medical or health related, as that information should be included in the previous questions.
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0/200
Additional Medication #1
Please include all medications the student will bring to camp. There is no need to input medications the student will not need to bring to camp except to inform staff of pertinent medical history in case of an emergency. If the medication is a controlled substance we request it be given to camp staff during student drop-off where it will be stored in a locked container until it is time to administer. If you do input medication info, please fill in ALL fields.
Check all that apply
Prescription medication
Nonprescription medication
Refrigeration required
Topical product or lotion
Food supplement
Modified diet
Name of medication
Enter "NA" if Not Applicable
Exact dosage
Enter "NA" if Not Applicable
To be administered at the following times
Enter "NA" if Not Applicable
Does the participant need help administering this medication?
YES
NO
Not Applicable
If the answer to the above question is "YES", please provide detailed instructions for how Natural Curiosity Staff must help the participant to administer the medication.
Additional Medication #2
Please include all medications the student will bring to camp if applicable. If the medication is a controlled substance we request it be given to camp staff during student drop-off where it will be stored in a locked container until it is time to administer.
Check all that apply
Prescription medication
Nonprescription medication
Refrigeration required
Topical product or lotion
Food supplement
Name of medication
Enter "NA" if Not Applicable
Exact dosage
Enter "NA" if Not Applicable
To be administered at the following times
Enter "NA" if Not Applicable
Does the participant need help administering this medication?
YES
NO
Not Applicable
If the answer to the above question is "YES", please provide detailed instructions for how Natural Curiosity Staff must help the participant to administer the medication.
Additional Medication #3
Please include all medications the student will bring to camp if applicable. If the medication is a controlled substance we request it be given to camp staff during student drop-off where it will be stored in a locked container until it is time to administer.
Check all that apply
Prescription medication
Nonprescription medication
Refrigeration required
Topical product or lotion
Food supplement
Name of medication
Enter "NA" if Not Applicable
Exact dosage
Enter "NA" if Not Applicable
To be administered at the following times
Enter "NA" if Not Applicable
Does the participant need help administering this medication?
YES
NO
Not Applicable
If the answer to the above question is "YES", please provide detailed instructions for how Natural Curiosity Staff must help the participant to administer the medication.
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Statements of Understanding
Please read through the below statements and policies carefully and indicate if you agree. The statements listed as required must be agreed to in order for your student to participate in the camp. YOU MUST SCROLL/READ THROUGH ALL THE TEXT IN THE BOXES TO BE ABLE TO SELECT "AGREE".
Photo/Video Release Permission
Natural Curiosity Staff will be taking photos & videos of participants during camp activities to document their experiences and share them with the participants friends/families. With your permission we would like the ability to use those photos/videos in our promotional materials, grant reports, and social media to promote further youth outdoor education programming. Our website, social media accounts and flyers are examples of how we use these photos/videos. We promise to always represent our participants in a respectful way and do not include any personal information with the photos/videos. We will also be happy to stop using any photos/videos if requested in the future. We understand not everyone would like to have photos/videos of themselves or their children shared in this way, so please indicate your preference below.
Program Participant Personal Medical Responsibility Policy
Our main goal is to provide participants with a safe outdoor learning experience. To facilitate this please review and accept the below policies. To summarize, if your child has a pre-existing medical condition that they have been prescribed rescue medication for THEY MUST HAVE IT WITH THEM and disclose it in the above "Medical Info" section. This especially includes RESCUE INHALERS FOR ASTHMA (exercise-induced they haven't experienced in years counts), EPI-PENS, INSULIN, SUGARY DRINKS/SNACKS (if needed for response to diabetes/low blood sugar).
Program Participant Personal Medication Administration Policy
This helps us accommodate participants who need medication during the program.
Natural Curiosity Provided First Aid
Our staff are trained in Wilderness First Aid to respond to minor injuries and medical incidents using standard Wilderness First Aid protocols. All incidents and treatment provided are recorded by camp staff in incident reports and SOAP notes and can be provided to you after the incident upon request. In the event that any injuries or medical incidents rise above "minor injuries and medical incidents", the parent/guardians will be contacted immediately and in the case of a medical emergency camp staff will contact 911. All student medical information is kept private and only shared internally with Natural Curiosity Staff as needed.
Summer Camp Conduct & Behavior Policy
To facilitate a positive and safe experience for your child, other participants, and Natural Curiosity Staff we require you to review and agree to our Camp Conduct and Behavior Policy. Please read through this policy with your child prior to camp. A copy of the policy is provided on the Natural Curiosity Summer Day Camp Participant Info & Registration Webpage.
Informed Consent and Assumption of Risk and Liability Waiver
Natural Curiosity has permission to secure emergency transportation (by calling 911) for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
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Type first and last name above to consent
Sign Document
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Date Signed
*
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Month
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Day
Year
Date Picker Icon
Natural Curiosity Email
example@example.com
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