2012 Summer Nature Day Camp Registration
Camper's Name Nickname (if any)
Date of Birth
School Attending in fall
How did you find out about us
Camp Session(s) Attending Wildlife Adventure – Morning session, June 25-29, Tualatin River National Wildlife Refuge, ages 4-6, 9am–noon, $135 Wildlife Adventure – Afternoon session, June 25-29, Tualatin River National Wildlife Refuge, ages 4-6, 1pm–4pm, $135 River Adventure 1, July 9-13, Summer Creek Natural Area, ages 11-13, 9am–4pm, $220 River Adventure 2, July 16-20, Summer Creek Natural Area, ages 7-10, 9am-4pm, $220 River Adventure 3, August 6-10, Summer Creek Natural Area, ages 11-13, 9am–4pm, $220 River Adventure 4, August 13-17, Summer Creek Natural Area, ages 7-10, 9am–4pm, $220
Primary Adult Contact
Adult Contact Relationship to Camper
Primary Phone Number Alternate Phone
Address City ZIP
Email
Emergency Contact
Secondary Contact Phone Number
People authorized to pick up camper
Physician's Name Insurance Company
Insurance Number
List any allergies or special needs