Camper Registration Form

Camper registration requires one form per camper, per camp season.

This form is mandatory to confirm your camp reservation. After it has been filled out, you can sign up for camps through online payment. If you already paid, and are just finding this form now, know that your reservation is not complete until both the camper registration form and payment are received.

Camper and Guardian Information
What Camp Season is this for?*
Camper Name:*
First Last
Camper Date of Birth:*
Date Format: MM slash DD slash YYYY
Gender*
Preferred Pronouns:
School Attending:*
Current Grade*
For fall and spring camp list the current grade of the camper. If you are registering for summer, list the grade the camper will be entering.
Parent/Guardian Name 1:*
First Last Phone
Parent/Guardian 1 Email:*
Parent/Guardian Name 2:
First Last Phone
Parent/Guardian 2 Email:
Address:*
Street Address City State ZIP Code
Camper Assistance/Needs
Medical, psychological, aide assistance, allergy, or relevant condition.
How did you hear about Dodge?*
Safety First
In emergency, contact parent/guardian listed above first?*
- Yes
- No
Additional Emergency Contact:
First Name Last Name Phone Relationship to camper?
Emergency Contact #1:*
Name Phone Relationship to camper?
Emergency Contact #2:*
Name Phone Relationship to camper?
Legalities
Media Permission*
Dodge Nature Center has permission to use my child in media and publications related to Dodge.
By signing this registration form I agree that: A) In the event of an emergency, I give permission for Dodge Nature Center to administer first aid and/or obtain emergency medical treatment for my child. I understand that, if necessary, my child will be transported by ambulance to the nearest hospital emergency room. I agree that any cost incurred for any transportation and/or treatment will be my responsibility. B) I understand I will be charged $5 for every 15 minutes if I am late to pick up my child. C) My child will not be permitted to leave with anyone except the person designated on the camp check-in sheet. D) DNC has the right to dismiss a camper without a refund for violating the center’s no tolerance policy. E) Students requiring supervision beyond the nature center’s child to staff ratio may need to provide an personal aide at my own expense.
Typed Parent/Guardian Signature*
First Last
Parent/Guardian Signature:*
Sign in this box with your finger, or your mouse cursor, the way you would with a pen.

Camps Overview

Camper Registration Form

Scholarships

Camper Registration Form

Camper registration requires one form per camper, per camp season.

Camper and Guardian Information

Safety First

Legalities

Camps Overview

Camper Registration Form

Scholarships

Camper Registration Form

Camper registration requires one form per camper, per camp season.

Camper and Guardian Information

Safety First

Legalities

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