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Register for Peace Camp 2023
Cost: $20
Please bring cash or check for payment at check in.
Lunch and snack provided. Open to children entering K-5th grade
.
REGISTRATION IS CLOSED
1. Participant's Name
2. Participant's Birthday
3. Participant's Age
4. Participant's Grade this fall
K
1st
2nd
3rd
4th
5th
5. Parent/Guardian Name
6. Parent/Guardian Cell Phone
8. Participant Cell Phone
7. Parent/Guardian Email
9. Participant Email
10. Participant's Address
11. All known allergies or medical conditions of which we should be aware (please explain):
12. Any known learning differences of which we should be aware (please explain)? Is there any best way to calm down your child when they get upset?
13. In the event of an emergency, if I cannot be contacted, I hereby authorize emergency treatment to be administered:
Yes (if yes, please continue with Question 14)
No (if No, please skip to Question 16)
14. If "Yes" to the above question, Physician's Name and Phone number:
15. Medical Insurance and Policy Number:
16. Emergency Contact Name:
17. Emergency Contact Phone Number:
18. Emergency Contact Relationship:
Parent
Guardian
Sibling
Grandparent
Other
Attendant T-Shirt Size
Youth Small
Youth Medium
Youth Large
Youth X-Large
19. I give permission for my child to be photographed while participating in Peace Camp events with the understanding that the photos will not be posted with my child’s name without additional permission.
Yes
No
20. I give permission for the participant to participate in supervised neighborhood walks with the Peace Camp staff.
Yes
No
Parent/Guardian Signature (typing your name will act as your signature):
Today's Date
Yes! I would like to subscribe to the Peace Camp Newsletter to stay informed about Peace Camp and Peace Ambassadors
Submit Registration
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