2025 - Big Brain Adventurers Registration

Big Brain Adventurers 2025

OUTDOOR PA DAY CAMP REGISTRATION
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
What grade will your child be entering in the 2025-26 school year?
Parent/Guardian's Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*
Please enter a valid phone number.
Parent/Guardian's Name

First NameLast Name
Address (if different from above parent/guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Are there custody arrangements pertaining to your child?*

YesNo
Emergency Contact #1*

First NameLast Name
Emergency Contact #1*
Please enter a valid phone number.
Emergency Contact #2*

First NameLast Name
Emergency Contact #2*
Please enter a valid phone number.
Attending:

Friday, September 19 - $65Friday, October 24 - $65
Does your child have life-threatening or nonlife threatening allergies?*

YesNo
If yes, please explain in detail:
Does your children have any medical concerns or diagnoses? If yes, please explain:*
Do you give permission for your child to be photographed for media purposes? (Big Brain Adventurers Instagram account, Facebook page or website?)*

YesNo
How did you hear about Big Brain Adventurers?*

Facebook groupInstagramGoogleWord of mouthOther (please state below)
Other:*
Statement of Consent & Waiver

I {parentguardiansName6} of {address} hereby agree and declare that I am the legal parent/guardian of {childsName} and hereby consent to my child's participation in the physical activities of Big Brain Adventurers that are described to me during the registration process. While my child is under the supervision of the Director and Camp Facilitators of Big Brain Adventurers, I understand that physical activities of the outdoor program may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

If {childsName} requires any emergency medical treatment or procedures during the activities, I hereby consent to Big Brain Adventurers Director: Jolena DePaulo and Camp Facilitators to make any decision and take any action to arrange for such procedures or treatments at their discretion and from guidance of the Big Brain Adventurers Director.

I, {parentguardiansName6}, hereby agree and declare that I have carefully read and understand the scope of the Big Brain Adventurers summer camp activities and I consent to the participation of {childsName} to these activities.

Any type of injury that may occur to the child without the fault of the Camp Director and Camp Facilitators, Big Brain Adventurers and staff cannot be held responsible for any harm that may occur to my child.
Signature for Consent & Waiver*

Clear
CANCELLATION POLICY:

No refunds will be issued for cancelled registration for PA day camp.

Credit for individual program days during the 2026 summer camp season will be issued in lieu of cancellations and refunds.
I have read and agree to the cancellation policy*

Yes
Once I have received your registration, I will send you an email within 48 hours.

Please check your email (and junk mail, just in case!) for confirmation of registration and for payment instructions!
Should be Empty:

Big Brain Adventurers 2025