Child Information Form – Catskill Animal Sanctuary

Camper #1

Child’s Name:*

Child’s School:*

Child’s Gender

Male
Female

Session(s) attending:

Camp Kindness - Ages 8-11
CK Teens – Ages 12-16

Select Sessions to attend

Session 1: July 8-12
Session 2: July 15-19
Session 3: July 22-26
Session 4: July 29-August 2

Add a Camper

Add a Camper

Camper #2

Child’s Name:*

Child’s School:*

Child’s Gender

Male
Female

Session(s) attending:

Camp Kindness - Ages 8-11
CK Teens – Ages 12-16

Select Sessions to attend

Session 1: July 8-12
Session 2: July 15-19
Session 3: July 22-26
Session 4: July 29-August 2

Add a Camper

Add a Camper

Camper #3

Child’s Name:*

Child’s School:*

Child’s Gender

Male
Female

Session(s) attending:

Camp Kindness - Ages 8-11
CK Teens – Ages 12-16

Select Sessions to attend

Session 1: July 8-12
Session 2: July 15-19
Session 3: July 22-26
Session 4: July 29-August 2

Add a Camper

Add a Camper

Camper #4

Child’s Name:*

Child’s School:*

Child’s Gender

Male
Female

Session(s) attending:

Camp Kindness - Ages 8-11
CK Teens – Ages 12-16

Select Sessions to attend

Session 1: July 8-12
Session 2: July 15-19
Session 3: July 22-26
Session 4: July 29-August 2

PARENT/GUARDIAN INFORMATION

Name

First Last

Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Secondary Phone

Did someone refer you to our program?

If so, please write their name here

EMERGENCY CONTACTS

Please provide two emergency contacts who will be available during camp hours:

Name*

Relationship to child*

Primary Phone Number*

Secondary Phone Number

Name*

Relationship to child*

Primary Phone Number*

Secondary Phone Number

PICK-UP AND DROP-OFF*

Please list the names of the individuals who are allowed to pick up your child.

GENERAL INFORMATION ABOUT YOUR CHILD

Please tell us a little bit about your child!*

A few sentences are fine.

Has your child attended summer camp before?*

Yes
No

What camp(s) were attended, and what was your child’s overall experience?

Why would you like your child to attend Camp Kindness?*

Is there anything else you would like us to know about your child?*

HEALTH INFORMATION

1. Has your child had any serious illness, injury, or surgery in the past year?*

Yes
No

Please explain:

2. Does your child have any allergies or special dietary needs?*

Yes
No

Please explain:

3. Is your child currently taking any medications?*

Yes
No

Please list medications:

Will these medications need to be taken during the program, from the hours of 9 a.m. to 3 p.m. (or until 5 p.m. during aftercare if applicable)?

Yes
No

please describe (what time is the medication taken at, is it taken with food, etc.):

4. Is there anything else you’d like to share about your child’s emotional, mental, or physical health that will help us serve your child?*

Yes
No

Share information

Name of Child’s Doctor:*

Doctor’s Phone Number*

Health Insurance Carrier, if any

Health Insurance Phone Number

Policy Number

Please write the month and year(s) when your child received the following vaccines. If your child is exempt, please write "exempt".

DTaP/DTP/Tdap/Td*

Hepatitis B*

MMR*

Polio (OPV)*

OTHER INFORMATION

How did you hear about our program?*

STAY IN TOUCH

Would you like to sign up for our newsletter?*

Yes
No

You’ll get news and updates from the sanctuary, vegan recipes, and more! You can unsubscribe at any time.

RELEASE AND LIABILITY WAIVER

Please read LIABILITY WAIVER in full and electronically sign by entering your child’s name, your name, and the date below.

Consent*

BY TYPING MY NAME IN THE FIELD BELOW I AM ACCEPTING THE TERMS AND CONDITIONS ABOVE.

Full name of minor child(ren)*

Full name of parent/guardian*

Today’s date

Camper Information Form

Camper #1

Camper #2

Camper #3

Camper #4

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACTS

GENERAL INFORMATION ABOUT YOUR CHILD

HEALTH INFORMATION

OTHER INFORMATION

STAY IN TOUCH

RELEASE AND LIABILITY WAIVER

Subscribe to Herd Around The Barn

Camper Information Form

Camper #1

Camper #2

Camper #3

Camper #4

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACTS

GENERAL INFORMATION ABOUT YOUR CHILD

HEALTH INFORMATION

OTHER INFORMATION

STAY IN TOUCH

RELEASE AND LIABILITY WAIVER

Subscribe to Herd Around The Barn