Summer Camp Registration Summer Camp Registration 2023 "*" indicates required fields Parent/Guardian Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Are you a Woodland Dunes member?* Yes No Camper InformationThe following adults have permission to drop off and pick up my child.*Child's Name* First Last Child's Date of Birth* Please share any additional information that we should know about your child.Emergency InformationDaytime Emergency Contacts*List at least two emergency contacts. Include name, relationship to child and phone number. Insurance Carrier* Insurance I.D. #* Preferred Hospital* Medical Treatment* I hearby authorize my child to receive emergency medical treatment in the event that it is necessary. I do not authorize my child to receive emergency medical treatment in the event that it is necessary. My child has the following health conditions and/or allergies (please include food allergies as snack may be provided).*I hereby grant permission to Woodland Dunes Nature Center, the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.Photography & Video Release Authorization* By checking this box I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes. By checking this box I am refusing to acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes. Choose The Summer Camps Your Camper Will AttendI would like to register my camper for:* Little Wings Summer Camp: Exploring Mud and Soil Little Wings Summer Camp: Exploring Water Little Wings Summer Camp: Exploring Sun and Wind Bees, Bugs and Blossoms Summer Camp: Friday, July 14th Nature Explorers Free Play Summer Camp, June 15-16th Animal Super Powers: Thursday, July 6th Little Wings Summer Camp: InsectsAges 4-6 years (have not completed kindergarten) Thursday, June 29th, 2023 9:00-11:30amMember Cost of Little Wings Summer Camp: Exploring Mud and SoilSorry, this session is full.Non-Member Cost of Little Wings Summer Camp: Exploring Mud and SoilSorry, this session is full.Little Wings Summer Camp: Exploring WaterAges 4-6 years (have not completed kindergarten) Friday, July 7th, 2023 9:00-11:30amMember Cost of Little Wings Summer Camp: Exploring WaterSorry, this session is full.Non-Member Cost of Little Wings Summer Camp: Exploring WaterSorry, this session is full.Little Wings Summer Camp: Exploring Sun and Wind Ages 4-6 years (have not completed kindergarten) Friday, August 4th, 2023 9:00-11:30amMember Cost of Little Wings Summer Camp: Exploring Sun and WindSorry, this session is full.Non-Member Cost of Little Wings Summer Camp: Exploring Sun and WindSorry, this session is full.Water is Wonderful Summer Camp Ages 6-11 years Friday, June 30th, 2023 1:00-3:30pmMember Cost of Water is Wonderful Summer CampSorry, this session is full.Non-Member Cost of Water is Wonderful Summer CampSorry, this session is full.Bees, Bugs and Blossoms Summer Camp Ages 4-7 years Session 1: Friday, July 14th, 2023 Session 2: Wednesday, August 2nd, 2023 9:00-11:00amMember Cost of Bees, Bugs and Blossoms Summer Camp: Friday, July 14thSorry, this session is full.Non-Member Cost of Bees, Bugs and Blossoms Summer Camp: Friday, July 14thSorry, this session is full.Member Cost of Bees, Bugs and Blossoms Summer Camp: Wednesday, August 2nd Price: 1 spots available. Non-Member Cost of Bees, Bugs and Blossoms Summer Camp: Wednesday, August 2nd Price: Nature Explorers Free Play Summer Camp Ages 7-12 years Thursday, June 15th - Friday, June 16th, 2023 Thursday, July 20th - Friday, July 21st, 2023 1:00-3:30pmMember Cost of Nature Explorers Free Play Summer Camp, June 15-16th Price: 7 spots available. Non-Member Cost of Nature Explorers Free Play Summer Camp, June 15-16th Price: 7 spots available. Member Cost of Nature Explorers Free Play Summer Camp, July 20-21stSorry, this session is full.Non-Member Cost of Nature Explorers Free Play Summer Camp, July 20-21stSorry, this session is full.Animal Super Powers Summer Camp Ages 7-11 years Thursday, July 6th, 2023 Friday, July 28th, 2023 1:00-3:30pmMember Cost of Animal Super Powers Summer CampSorry, this session is full.Non-Member Cost of Animal Super Powers Summer CampSorry, this session is full.Member Cost of Animal Super Powers Summer Camp: Thursday, July 6th Price: 3 spots available. Non-Member Cost of Animal Super Powers Summer Camp: Thursday, July 6th Price: 3 spots available. Total Payment InformationPayment Type* Check PayPal If you would like to pay by check, please write summer camp & your child's first name in the memo line and mail to: Woodland Dunes Nature Center Summer Camp P.O. Box 486 Two Rivers, WI 54241-0486
