Register for Camp | Northwest Danish Camp

Acceptance of Camp Behavior Policy & Anti-Bullying Agreement
Code of Conduct Agreements*
- By checking here I am stating that I have read and agree to abide by all policies contained with the anti-bullying policy and behavior agreement. Furthermore I certify that I have discussed all the policies and their meanings and consequences with my child(ren).
Camper details
Name*
First Last
Gender*
Age*
Birthdate*
Date Format: MM slash DD slash YYYY
Grade completed (prior to camp starting)*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Enter Email Confirm Email

Parent Info
Parent or Guardian names*
Parent Phone (Home)*
Parent Phone (Cell)*
Parent Phone (Work)*
Parent Email*
Enter Email Confirm Email
Getting to Camp
Who will BRING Camper TO camp?*
Who will PICK UP Camper FROM camp?*
Emergency contact
Please list name, contact info (home, work and cell) and relationship for person to contact if Parent or Guardian above cannot be reached.
Emergency Contact Name*
First Last
Relationship*
Emergency Contact Phone*
Emergency Contact Phone (Cell)*

Camper Health Information
Present medication(s)*
Camper must bring medications to camp and turn into Camp Nurse
NOTE: If none, please write NONE.
Physical, behavioral, or emotional concerns*
Please list concerns that staff should know about.
NOTE: If none, please write NONE.
Allergies, including to medications & severe food allergies*
NOTE: If none, please write NONE
Health Insurance & Family Doctor
Health insurance provider*
Group number*
ID Number*
Name of primary person insured*
Insurance provider phone number*
Family doctor practice name
Family doctor city
Family doctor phone number*
Date of last tetanus shot/booster*
Date Format: MM slash DD slash YYYY

Special Permissions
Photography*
I grant the right to photograph my child and use the photo reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the internet.
- I agree
- I disagree
Non-prescription pain medication*
I grant the right for Staff to give my child non-prescription pain reliever, if needed.
- I agree
- I disagree
The Northwest Danish Association Newsletter
- We'd like to subscribe! (parent or person filling in this form)

Camp Fees
Camp Tuition
Early Bird ended March 31st. Please remember, to qualify for the NWDA membership price, the camper or the parent must be a current NWDA member (sorry, grandparent memberships don't qualify for the membership discount).
- NWDA Member - $800
- Non-NWDA Member - $875
Camp Tuition Early bird*
Early Bird pricing through March 31 ($50 off) Please remember, to qualify for the NWDA membership price, the camper or the parent must be a current NWDA member (sorry, grandparent memberships don't qualify for the membership discount). After March 31st, regular tuition prices apply
Optional Requests
- Bedding provided by Menucha
- Special diet request
Payment Method*
Please be sure to send in your payment as soon as possible after filling in this form. We will not be sending an invoice. Thank you.
- Credit card
- Check
Total
$0.00
Almost there! Just two more steps
After you click Submit below, you'll get details on how to make your payment and how to complete your special diet request (if selected).
Signature*

Acceptance of Camp Behavior Policy & Anti-Bullying Agreement