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Camper's Preferred Name
Age Camper will be the Dates of Camp
Grade Completed this Year 12th grade 11th grade 10th grade 9th grade 8th grade 7th grade 6th grade 5th grade 4th grade 3rd grade
Gender Male Female Nonbinary
Relation to Camper
Email *
Phone *
City Parent/Guardian will be During the Week of Camp
Relation to Camper
Email
Phone
Is One or More Parent/Guardian an Active Member of the Northwest Danish Association? Yes No Third Choice
Tuition Himmelbjerget Person(s)
Person(s) who will Drop Camper off at Himmelbjerget
Person(s) who will Pick Camper up from Himmelbjerget
Relation to Camper
Phone *
City Where Emergency Contact will be During the Week of Camp
Food Allergies (please include reaction)
Non-Food Allergies (please include reaction)
Does Camper have an Epi-pen for Above Allergies? N/A Yes No
Has Camper been Stung by a Bee? Yes, with no reaction Yes, with a moderate reaction No
If applicable, please provide more information about above listed conditions
Does Camper Know How to Swim? Yes Yes, but not well No
Health Insurance Provider
Health Insurance ID/Group
Primary Person Insured
Health Insurance Phone Number
Primary Care Provider
City Where Primary Care Provider is Located
Primary Care Provider Phone Number
Photography Release: I grant Himmelbjerget Danish Camp the right to photograph my child and use the photo reproduction of their physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the internet. I agree I do not agree (please email camp director)
Inclusivity Policy: Himmelbjerget is dedicated to providing a welcoming and inclusive camp experience to all campers and counselors, regardless of gender or sexuality. Campers who disclose a transgender, nonbinary, or gender nonconforming identity on their registration will be contacted by the Camp Director to determine the dormitory assignment the camper would feel most comfortable with for their week at camp. As a default, campers will be assigned to dorms on the basis of gender identity. A trans* identity that is disclosed in a camper registration form will not be shared with those outside of the counselor team unless requested otherwise by the camper. Himmelbjerget will uphold a zero-tolerance policy for any form of LGBTQ+ discrimination. I acknowledge Other
Will You Be Paying for an Alternative Diet? (+$60) N/A Yes
Is Camper Applying for Tuition Scholarships? If yes, from where?