Which camp(s) are you registering for? Check all that apply. *

At the Pond (June 17 - 20)

In the Forest (July 8 - 11)

On the Farm (July 29 - August 1)

Child #1 *

First Name

Last Name

Age at time of camp *

5

6

7

8

9

10

11

Birthdate Child 1 *

Child should be 5-11 years old at the time of camp

MM

DD

YYYY

Child #2

Enter discount code E5EXNV8 at checkout for child living in same household, attending same camp week

First Name

Last Name

Age

5

6

7

8

9

10

11

Birthdate Child 2

Child should be 5-11 years old at the time of camp

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Primary Phone *

(###)

###

####

Emergency Contact *

In the event we are unable to reach parent/guardian listed on this form

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Primary Care Provider

First Name

Last Name

I give permission for Oceana Conservation District to use photographs of my child during programming for promotional purposes *

Yes

No

I release Oceana Conservation District from liability in case of accident during activities when proper safety procedures have been taken *

Yes

Camp Enrollment Confirmation *

I understand that my camper(s) are not fully registered and their space in camp is not guaranteed until the non-refundable deposit or complete payment is received.

I will go to the shopping cart and make complete payment now

I will go to the shopping cart now and make a $50 deposit for each camp week.

Pay It Forward *

I would like to purchase a week of Nature Day Camp for a child who would not otherwise be able to attend.

Yes, I will add this to my shopping cart.

No, I am unable to Pay It Forward at this time.