PEACE Camp 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*

Date

What school does your child currently attend?*

What grade will your child be entering in Fall 2026?*

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.

My child is allowed to walk home each day after camp. (If "no" then someone must be available to pick your child up daily)*

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.*

Cheryl's Lodge/CAPTAIN CHS sometimes use pictures/videos for promotional materials and on our social media. Do you consent to pictures/videos being taken of your child during camp for these purposes?*

Camper's T-Shirt Size:*

Camper's Ethnicity (This information is gathered as part of the Summer Food Service program which Cheryl's Lodge and PEACE Camp participate in. This information is used for data collection purposes only and your participation is fully optional)

Camper's Racial Identity (This information is gathered as part of the Summer Food Service program which Cheryl's Lodge and PEACE Camp participate in. This information is used for data collection purposes only and your participation is fully optional)

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.

I have read and agree to all the above.*

PEACE Camp Registration Form 2026