2026 CPNS Summer Camp Registration
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Preferred Nickname
Choose which sessions you would like your child to attend:
*
FULL WAITLIST ONLY Session 1 - June 22-24: Sensory Garden
FULL WAITLIST ONLY Session 2 - June 29-July 1: Nature Magic
FULL WAITLIST ONLY Session 3 - July 6-8: Garden Explorers
FULL WAITLIST ONLY Session 4 - July 13-15: Garden Science
FULL WAITLIST ONLY Session 5 - July 20-22: Outdoor Artist
FULL WAITLIST ONLY Session 6 - July 27-29: Bugs & Blooms
FULL WAITLIST ONLY Session 7 - August 3-5: Rainbow Garden
Parent/Guardian Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Email
*
Does your child have allergies?
*
Yes
No
Please list them here:
Conditions requiring special consideration (medical/physical):
Does your child require:
*
Epipen
Inhaler
Any type of medication
None
If requiring medication, please elaborate:
Emergency Contact #1
*
Emergency Contact #2
*
Student's Physician and Phone Number
*
Medical Release Authorization
*
I hereby authorize the release of my child's pertinent medical information to the appropriate professional staff. I give permission to the physician or hospital to secure treatment for my child, including medications, injections, anesthesia, or surgery, in case of emergency. The checkbox constitutes authorization to perform any necessary treatment for my child during the Summer Program.
Submit
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