2013 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 Refuge Adventure – Morning session, June 24-28, Tualatin River National Wildlife Refuge, ages 4-6, 9am–noon, $135/$150 River Adventure 1, July 8-12, Dirksen Nature Park, ages 7-10, 9am–4pm, $220/$250 River Adventure 2, July 29-August 2, Dirksen Nature Park, ages 11-13, 9am-4pm, $220/$250 River Adventure 3, August 12-16, Dirksen Nature Park, ages 7-10, 9am–4pm, $220/$250 River Adventure 4, August 19-23, Dirksen Nature Park, ages 11-13, 9am–4pm, $220/$250
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
