Clone of JMS Camp 2026 Registration Form

Who?
Students aged 7-10 by the start of camp. Limited space available to keep activity group sizes low for optimal experiential learning opportunities.

When?
June 22nd-26th, 9 AM – 2 PM daily.

Where?
Herring Gut Coastal Science Center, 59 Factory Road, Port Clyde, ME 04855.

Theme?
Oceanic Exploration! Build memories that last a lifetime while learning in nature's briny classroom. Each day, campers will experience firsthand the wonders of the ocean along Maine's rocky coastline. Every day brings new adventures: tidepooling, exploring plankton and the miniature life under microscopes, arts & crafts, and more!

Items to Bring?

backpack
waterproof/resistant shoes with closed toes (NOT sandals or Crocs) -limited wader boot sizes available on a first-come first first-served basis
refillable water bottle
sack lunch / extra snacks if needed (HG provides a daily snack)
towel
change of clothes (just in case)
sunscreen/bug spray (please apply a layer before start of camp)
a hat or sun visor

Student Information

All required questions are marked by an asterisk (*).

Student's Name*

First NameLast Name

Birth Date*

MonthDayYear

Grade level in fall 2026 (K - 12)

Preferred pronouns

He/him/hisShe/her/hersThey/them/theirsOther

Will any other family members be attending? If YES, list their names here and then complete a separate form for each.

Address (Seasonal residents: please list your camper's summer residence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Demographic Data

This information will not negatively affect your student's acceptance or ability to participate in any of our progams. It will be used to collect data for fundraising / grant writing purposes and to make appropriate accomodations for physical or educational needs.

Does your student qualify for free and reduced lunch?

YesNo

Does your student receive special education services from the school?

YesNo

What additional support might they need at camp?

What ethnicities or mix of ethnicities does the student have in their family heritage? (please mark all that apply)

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is the student prescribed an inhaler or emergency medical device? If yes, please explain any instructions. The emergency inhaler and/or device(s) must be on the camper at ALL times during camp. All HG staff are First Aid and CPR certified for camps and can assist with administration of the inhaler/device if needed.*

Parent/Guardian Information

This is the primary emergency contact that we will use, and any billing information will be sent to this person.

Parent/Guardian Name*

First NameLast Name

Relation to Student*

Phone Number*

Alt. Phone Number

E-mail*

example@example.com

Additional Contact Information

In case of emergency, we will FIRST contact the Parent / Guardian listed above. If that person does not respond we will then contact the person listed below.

2nd Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Emergency Contact E-mail*

example@example.com

Drop-off / Pick-Up Information

If there are any changes in drop-off/pick-up information at any point, please call us at (207) 372-8677.

What time & location will you drop off your camper each day?*

8:30 AM HG Van carpool at Knox Museum in Thomaston (30 High Street)8:50 AM at Herring Gut in Port Clyde (59 Factory Road)

What time & location will you pick up your camper each day?*

2:00 PM at Herring Gut (59 Factory Road)2:30 PM HG Van carpool at Knox Museum (30 High Street)

Who is allowed to pick up your camper from Marine Explorers camp? (choose any/all that apply)*

Parent / Guardian (listed above)Emergency Contact (listed above)Camper (will walk/bike home by themself)Will ride with a sibling or family friend (provide contact below)Other (provide contact below)

Name

First NameLast Name

Phone Number

Additional Information

Photo Release. I give Herring Gut Coastal Science Center permission to publish in print, electronic or video format the likeness or image of me/my child. I release all claims against the Herring Gut Coastal Science Center with respect to copyright ownership and publication including any claim for compensation related to use of the materials.*

I give HG permission to use photos of my child.I do NOT consent to give HG permission to use photos of my child.

Informed Consent and Acknowledgement

WAIVER OF LIABILITY, MEDICAL AUTHORIZATION & INDEMNIFICATION
All participants are required to read, acknowledge, and abide by the following policies:

The purpose of this document is to obtain information so that Herring Gut Coastal Science Center (HGCSC) may safely conduct events
and programs at our facilities and field sites to relieve HGCSC of all liability and expense to the greatest extent permitted under State
of Maine law.

1. Agreement to Provide Information. The undersigned participant (or guardian if under 18) agrees to:
Provide lead instructor with accurate information about participant capability and health. Provide medical information to the instructor
prior to participation in programming including, but not limited to, known allergies, current medications, medical problems, information
regarding insurance coverage, and any other relevant medication information requested by the instructor. Provide a contact in case of an
emergency. {parentguardianName}

2. Medical Authorization. HGCSC has my permission to authorize emergency medical treatment. {parentguardianName}

3. Waiver. The undersigned, for his/herself/their and his/her/their heirs and assigns, releases, waives, discharges and covenants not
to sue HGCSC for any loss or damage, or any claim or demand on account of injury to the undersigned’s person or property arising out
of or relating to an event or activity run by or sponsored by HGCSC, its employees, staff or agents, pair or volunteer, or upon property
of HGCSC or otherwise, including without limitation injury or damage that was caused by the negligence of HGCSC, its employees,
staff, or agents, caused by the negligence of the undersigned, or caused by the negligence of others.{parentguardianName}

4. Indemnity and Hold Harmless. The undersigned further agrees to indemnify and hold harmless HGCSC for any claims, damages,
judgments, court cost, legal fees, or any other expenses which HGCSC may incur because of a claim based on injury to the
undersigned’s person or property arising out of or relating to an event or activity run by or sponsored by HGCSC, its employees, staff,
or agents, paid or volunteer, or upon property of HGCSC or otherwise, including without limitation injury or damage that was caused
by the negligence of HGCSC, its employees, staff, or agents, caused by the negligence of the undersigned, or by the negligence of
others. {parentguardianName}

Confirmation

BY ACKNOWLEDGING AND SIGNING 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. I AM ACKNOWLEDGING THAT I HAVE READ, UNDERSTOOD, AND AGREED TO THE ABOVE WAIVER.

Signature*

Camp Registration*

In-state RegistrationPaid in Full

$250.00

Out-of-state RegistrationPaid in Full

$300.00

Camp DepositYou'll receive an invoice for the balance. Non-Refundable after May 1, 2026. Camp balance to be paid in full by June 1, 2026.

$50.00 Quantity

Please consider my camper for a need-based camp scholarship ($25 is needed to reserve space for a scholarship request-this will be returned to you if we cannot obtain scholarship funds. Decision on scholarships will be made no later than 1 month prior to the start of camp)

$25.00 Quantity

Total

$0.00

Marine Explorers Camp 2026