PEACE Camp 2026

PEACE Camp Registration Form 2026
For Shenendehowa Students going into grades 1-6.

Breakfast, Lunch, and Snack provided daily.

Dates: July 6th-July 30th (Mondays through Thursdays)

Time: 8:30am-2:00pm

Location: Cheryl's Lodge Outreach Center

Important dates:
Parent Orientation: Wednesday July 1st, 7-8pm
Parent Night: Wednesday, July 15th, 7-8pm
Celebration Night: Wednesday, July 29th, 7-8pm

PEACE Camp is a FREE summer camp that promotes teamwork, cooperation, problem-solving, and conflict resolution skills. It also encourages interpersonal skills and making new friends. Camp includes games, arts and crafts, weekly activities, planned activities, special guests, and field trips.
Camper Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
ArongenChangoKarigonOrendaOkteSkanoShatekonTesagoOther
1st2nd3rd4th5th6th
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship to Camper*
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Does your child have any allergies or medical conditions? If yes, please specify.*
Will your child need to take any medications during camp (to be administered by staff)? Please list the name of the medication, dosage, and directions for administering. A doctor's note will also be required prior to camp. *
Does your child have any dietary restrictions? If yes, please specify.*
Does your child have any behavioral needs or concerns we should be aware of? If yes, please specify.*
YesNo
Youth XSYouth SYouth MYouth LAdult SAdult MAdult LAdult XL
Hispanic or LatinoNon Hispanic or Latino
AsianBlack or African AmericanWhiteAmerican Indian or Alaska NativeNative Hawaiian or other Pacific Islander
I understand that this application does not guarantee my child a spot in PEACE Camp. If my child is selected to participate, I agree to the following:

1. I will make every effort to have my child attend ALL camp days. This an essential commitment for our parents/caregivers and children.

2. I understand that if my child exhibits behaviors deemed to be unsafe, disruptive, or harmful, they may be asked to leave camp.

3. I give my child permission to participate in all activities of the program and to receive minor medical treatment if necessary.

4. I agree to participate in the scheduled Parent Programs listed at the beginning of this form and on the PEACE Camp flyer.
Yes
Should be Empty:

PEACE Camp Registration Form 2026