Earth Adventures Summer Day Camps

Camp Weeks

Please select the camp dates you wish to register for.

 July 15-19, 2019

Name of Child*:


Name of Parent/Guardian*:




Emergency Contact Name*:

Emergency Phone*:

Drop off/pick-up person(s)*:

Please list any special interests your child has? (I.e. snakes, crafts, etc) :


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

Special Needs

Please indicate any special needs of camper :

Photo Release

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.

 Yes I give consent for photos No I do not give consent for photos

Release of Liability

In consideration of my child attending Earth Adventures 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 Nature Camp activities:

- trip and fall
- minor cuts and or abrasions
- insect bites / bee stings / poison ivy
- swimming (lifeguard on duty).

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

Cancellation Policy

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 June 10, 2018 – 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. Camp will run with a minimum of 10 camper registrations. We will contact you two weeks prior to camp, should we need to cancel. :

 Yes, I agree with the cancellation policy

I would like to order an Earth Adventures T-Shirt for an additional $20
 Yes No

If yes, please select size from this dropdown menu:

Note: When you click Send, it will bring you to a page with the total cost and PayPal button to complete payment.