Hackmatack Nature Camp Registration Form

Hackmatack Nature Camp Registration

Thank you for signing up for Hackmatack Nature Camp program! Please note that an invoice of $150 will be sent upon registering. This invoice holds the child's spot in the camp. The remaining balance is due two weeks before the camper's first session. We offer a 10% discount to those who pay in full by Feb. 28th, as well as a 15% sibling discount for each additional child enrolled. Hackmatack believes that the outdoors should be accessible to every child! If you'd like to discuss payment plans or are interested in potential scholarship opportunities, please reach out with any inquiries to aram@hackmatack.org.
Camper's Information
Name

First NameLast Name
Birth Date

MonthDayYear
Age (at time of camp)
Parent / Guardian Information

(All correspondence and invoices will be sent to this person)
Name

First NameLast Name
Relationship to the Camper
Email
example@example.com
Cell Phone
Work Phone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts and Authorized Pick Up Persons
Program Selection
Select Camp Session

July 7th - July 11th- WAITLISTJuly 14th - July 18th-WAITLISTJuly 28th - August 1st-OPEN
If selected the April Session, please specify which days. Please note, cost is $65/day

Tuesday, April 8thWednesday, April 9thThursday, April 10thFriday, April 11th
Add-ons

8:00 AM early drop off ($50/week)4:00 PM late pick up ($50/week)
Working with the camper, please select any topics that are of interest to them! This will help us place the camper in the best group during the camp.

ConservationEcosystemsWeatherRecyclingPlant CycleInvasive SpeciesPlant IdentificationAnimal TrackingMapping + NavigationPollinationSurvival SkillsAgricultureSustainabilityHuman Impact on the EnvironmentRenewable EnergyAnimal HabitatsTeam BuildingWetlands EcologyDesign + Creative Building
If your camper has a friend that they would like to be in the same group together, please list the name here. There is no guarantee that they will be grouped together, but we will take the request into consideration.
Additional comments or questions
Medical
The camper is allergic to:

No Known AllergiesFood (Please specify below)Medicine (Please specify below)Environment (Please specify below)
Please describe what the camper is allergic to and the reaction seen.
Please list any medications, alongside the frequency, that the camper must take during camp hours.
Does the camper use an epi-pen?
Does the camper use an inhaler?
Does the camper have an Asthma Action Plan?
What Have We Forgotten to Ask? Please provide in the space below any additional information about the camper’s health that you think important or that may affect thecamper’s ability to fully participate in the camp program.
By checking Yes, I give permission for Hackmatack Farm + Playhouse to use photos and/or videos of my child at camp for theater promotion on social media such as Facebook, Instagram, and the Hackmatack Website.

YesNo
By checking yes, I give permission for Hackmatack Farm + Playhouse Staff or appointees to administer first aid and basic medical care to my child as needed; as well as permission to transport my child to the nearest hospital in case of emergency.

YesNo
Space to communicate any additional questions, comments etc.
This health history is correct and accurately reflects the health status of the camper to whom it pertains. The camper described has permission to participate in all camp activities except as noted by me and/or an examining physician.

First NameLast Name
Should be Empty:

Hackmatack Nature Camp Registration

Camper's Information

Parent / Guardian Information

Program Selection

Medical