Southlands Nature Camp Enrollment Form

Southlands Nature Camp Enrollment Form

Thank you for joining us for a summer of Southlands fun! Please complete one form for each child you are enrolling for nature camp. Please note that spaces are limited. if you have any questions, don't hesitate to reach out to our office at (856) 876-4862.
Camper's Information

Nature camp is for children between the ages of 4-6. Please keep this in mind while filling out the following information.
Camper's Name*

First NameLast Name
Age *
Date of Birth*

MonthDayYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this the camper's first time at Southlands?*
Is this the camper's first time attending camp at Southlands?*
Please list the campers tee shirt size*
Camper's Photo (Optional)

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Parent/Guardian Information
- The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
- The parents/guardian listed below will also be the primary emergency contact person.
Primary Contact Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Relation*
Secondary Contact Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Relation*

Medical Information

Camper's medical information is only available to our primary staff.
Primary Physician name *
Primary Physician Contact*
Insurance Company Name*
Member ID*
Subscribers Name*
Policy #*
My child has permission to engage in all camp activities*
If no, please elaborate on restricted activities
Does the child have any allergies? If yes, please list them below:
Does the child have any previous injuries? If yes, please explain them below:
Does the child have any current medical conditions? If yes, please list them below:
Does the child takes any medication? If yes, please list them below and explain its purpose:
Parents must submit a current immunization record demonstrating compliance with New York State immunization requirements for school-age children. Records must be received prior to the start of camp. Upload here or contact our officed at (845)876-4862 to submit another way.

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Enrollment Options

Please choose the weeks you would like to enroll your child in. Each week of enrollment is $525, with a 15% discount for siblings. We also offer aftercare between 3-5 for parents who aren't able to pick their campers up right at 3. We will reach out to let you know if we are unable to accommodate, as we are offering this on a first-come, first-serve basis per week. Aftercare is an additional $100 per week. Once you choose your session(s), someone from our team will forward a payment link to your primary contact's email via our QuickBooks account. If you have any questions or concerns, please don't hesitate to reach out to our office at (845) 876-4862.
First Session - June 29th - July 3rd
First Session - June 29th - July 3rd + Aftercare
Second Session - July 6th - 10th
Second Session - July 6th - 10th + Aftercare
Third Session - July 13th - 17th
Third Session - July 13th - 17th + Aftercare
Fourth Session - July 20th - 24th
Fourth Session - July 20th - 24th + Aftercare
Fifth Session - July 27th - 31st
Fifth Session - July 27th - 31st + Aftercare
Sixth Session - August 3rd - 7th
Sixth Session - August 3rd - 7th + Aftercare
Seventh Session - August 10th - 14th
Seventh Session - August 10th - 14th + Aftercare

Riding Waiver & Authorization
The Southlands Foundation Release and Waiver of Liability 2026
- I request that I be allowed to ride horses and ponies on or about the property owned by The Southlands Foundation and on lands adjacent thereto, and to do each and everything necessary pertaining to such riding, including the care of stock, grooming, handling, tacking, etc.
- I understand that horseback riding involves risk of injury from falling, the behavior of the animals, ground hazards (natural and otherwise) and other risks. I accept those risks.
- I agree to indemnify and hold harmless The Southlands Foundation, its agents and employees, for any claims for damages to my person or property resulting from or arising out of negligence on the part of The Southlands Foundation, its agents or employees. I understand that this means I will not seek to hold The Southlands Foundation responsible for any injuries, sickness and disease (including communicable diseases), I sustain as a result of these activities. I further agree to indemnify and hold harmless the above named, their agents and employees from any and all claims from injuries and/or damage to the person or property of any third party or parties resulting from my participation in the above activities.
- I also agree that The Southlands Foundation, its agents and employees, are not to be responsible for any or all losses due to fire or theft, and I agree to indemnify and hold harmless The Southlands Foundation, their agents and employees for any claims arising there from.
- In the event I ride on property adjacent to The Southlands Foundation, including property owned by Dove’s Nest LLC and its members, I agree to indemnify and hold harmless the owners of such adjacent property from any and all claims for injury or damage to my person or property or the person and property of any third party resulting from my participation in the activities described above.
- I acknowledge that I have carefully read the rules of riding safety which are posted at The Southlands Foundation and agree to abide by those rules.
- I acknowledge that I have carefully read this Release and Waiver of Liability, understand its contents and sign it as my own free act.
Authorization
- I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
- I released the organizers, trainers, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
- I confirm that all information given in this form is true, complete, and accurate.
- I understand that while The Southlands Foundation strives to accommodate all interested families, they do reserve the right to decline or discontinue camp registration at their own discretion when they believe a program is not the best fit. This policy exists to ensure the safety, well-being, and positive experience of all campers, staff, and animals.
Parent/Guardian Signature

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Southlands Nature Camp Enrollment Form

Camper's Information

Parent/Guardian Information

Medical Information

Enrollment Options

Riding Waiver & Authorization