Please select the camp dates you wish to register for.
PA Day Camp Sept. 27, 2019
Name of Child*:
Name of Parent/Guardian*:
Emergency Contact Name*:
Drop off/pick-up person(s)*:
Please indicate any allergies of camper
Has your child had an anaphylactic reaction and/or do they require an epi-pen or other auto-injector?
Yes (if yes, GreenUP’s Anaphylaxis Form must be completed and submitted prior to camp) No
Please indicate any special needs of camper
I hereby give GreenUP permission to use the child's name, photograph, video recording, audio recording, and/or likeness (collectively referred to as “Their Image”) as they deem fit and appropriate to GreenUP’s purposes.
I am aware and agree that Their Image may be used in all forms including, but not limited to, media for broadcast or in printed publications, on GreenUP’s websites, in public displays, or in GreenUP publications.
I am aware that GreenUP may share Their Image with program partners and funders for their limited use, as it relates to a program or event.
I waive any right to inspect or approve any publication of Their Image by GreenUP.
I understand that GreenUP cannot control unauthorized use of Their Image by persons not associated with GreenUP once their Image has been published.
I have carefully reviewed and understand the above provisions and agree to be bound by them. I voluntarily and irrevocably give my consent and agree to this Release and Waiver.
Release of Liability
In consideration of my child attending Earth Adventures PA Day Camp with GreenUP, I recognize and acknowledge that there are inherent risks and hazards involved in regular camp activities (ie. hiking, active group games, etc.). The following is a non-exclusive list of possible risks that could be encountered while participating in Earth Adventures PA Day Camp activities:
- trip and fall
- minor cuts and or abrasions
- insect bites / bee stings / poison ivy
I freely and voluntarily agree to assume such risks, and hold harmless and indemnify GreenUP from any and all liability. I hereby waive any and all claims against GreenUP, including its staff, volunteers, directors, and agents arising out of my child's participation with the organization.
Yes, I agree to these terms and conditions
All camps must be paid for in full at time of registration. All cancellations must be made in writing. A full refund will be granted before September 20, 2019 – cancellations after this date will result in complete forfeiture of camp fees. No refund, reduction of fees, or credit will be granted for late arrival, early departure, withdrawal, or dismissal. All payments are non-transferrable. If a camper is unable to attend due to medical reasons a full refund will be granted.
Yes, I agree with the cancellation policy
Note: When you click Send, it will bring you to a page with the total cost and PayPal button to complete payment. Registration is not confirmed until you receive an email confirming your registration and payment.