sarah p. duke gardens camp registration form€¦ · sarah p. duke gardens camp registration form...
TRANSCRIPT
Sarah P. Duke Gardens Camp Registration Form
Submit one copy of this form per child.
Personal Information Child’s name Child’s age Child’s date of birth Child’s school Child’s grade level* Home address Parent/Guardian’s name Relationship to child Email
Parent/Guardian’s name Relationship to child Email
Best phone number to reach you (with questions or in case of emergency) Can we text this number? yes
Alternate phone number Can we text this number? yes Please list all people who may pick up your child. We require I.D. at pickup.
* current grade for spring break camp; grade in fall for summer camp
Camp Sessions: select all camps & extended care sessions you want to register your child for April 2-6: Spring Break Camp (current K-5), 9 a.m. – 1 p.m. no extended care June 11-15: Plant It, Grow It, Eat It (rising K-2), 9 a.m. – 1 p.m. extended care (1-4 p.m.) June 18-22: Inventions from Nature (rising 3-5 , 9 a.m. – 1 p.m. extended care (1-4 p.m.) June 25-29: Animals in the Gardens (rising K-2), 9 a.m. – 1 p.m. extended care (1-4 p.m.) July 9-13: Art and Science (rising K-2), 9 a.m. – 1 p.m. extended care (1-4 p.m.) July 16-20: Eco Artists (rising K-2), 9 a.m. – 1 p.m. extended care (1-4 p.m.) July 23-27: Plant It, Grow It, Eat It (rising 3-5), 9 a.m. – 1 p.m. extended care (1-4 p.m.) July 30-August 3: Artists in the Gardens (rising 6-8) , 9 a.m. – 1 p.m. no extended care
Health Information: Duke Gardens will not be responsible for any accident, injury, or loss, however sustained, to your child or child’s property, or for personal injury or mishap. All activities are at the risk of the participant. If you do not wish your child to participate in a particular activity, please notify camp staff. Please list medical limitations, allergies, medications or dietary restrictions:
Emergency contact, if different from Parent/Guardian information above: Emergency contact name Relationship to child Phone
Health Authorization: I believe that my child is physically and mentally capable of participating in the Nature Adventures Day Camp at Sarah P. Duke Gardens. I verify that you have permission to take my child to the nearest medical facility for emergency treatment. I understand that Duke Gardens is not liable in any way for injury or medical expenses.
Signature and date Printed name
Media Release: Duke Gardens occasionally uses photos from camps in its annual report, education guide or other print publications, or as a program promotion online. We do not identify children by name in these phots. Please check here if you do not want your child featured in any of these photos:
Where did you find out about our camps?
Deposit of $100 per child, per camp is required to confirm registration. Full payment is due at least 2 weeks before camp begins. To submit your camp form, get more information, or ask questions:
In person: Registrar, Doris Duke Center, 420 Anderson St, Durham, NC 27705 Mail: Registrar, Sarah P. Duke Gardens, Box 90341-ED, Durham, NC 27708 Website: gardens.duke.edu/learn/camp
Phone: 919-668-1707 Fax: 919-668-3610 Email: [email protected]
Sarah P. Duke Gardens reserves the right to cancel camp if enrollment is not met.