Camper Registration (Active) - Himmelbjerget Danish Camp

Camper Information

Camper's Legal Name

First

Last

Camper's Preferred Name

Date of Birth

Age Camper will be the Dates of Camp

Grade Completed this Year

Gender

Pronouns

She/Her
He/Him
They/Them

Years of Camp Attended

T-Shirt Size

adult unisex sizing

Danish Language Fluency

Selected Value: 1

Ranked from beginner to fluent; this will help us place your child in the appropriate language class

Camper's Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

This is the address we will mail the pre-camp packet and other information to

Camper's Email

If applicable

Camper's Cell Number

Parent/Guardian Information

Parent/Guardian Name

First

Last

Relation to Camper

Email

Phone

City Parent/Guardian will be During the Week of Camp

Additional Parent/Guardian Name

First

Last

Relation to Camper

Email

Phone

Is One or More Parent/Guardian an Active Member of the Northwest Danish Association?

Person(s) who will Drop Camper off at Himmelbjerget

Person(s) who will Pick Camper up from Himmelbjerget

Emergency Contact

Name

First

Last

team comfortable Camper

Relation to Camper

Phone

City Where Emergency Contact will be During the Week of Camp

Health & Medical Information

Camper's Diet

To accommodate non-general diets, the Menucha Retreat and Conference Center requires families to submit an ‘Alternate Diet Form’ and pay a $60 meal fee. The link to that form is found at the top of this web page and will also be made available once registration is submitted. The fee will be paid directly to Himmelbjerget as an add on to your tuition payment. If your camper has an allergy or food restriction that may not warrant a modification to most meals, please reach out to the director and we will work with Menucha together to see if an accommodation is needed.

Food Allergies (please include reaction)

Non-Food Allergies (please include reaction)

Does Camper have an Epi-pen for Above Allergies?

Has Camper been Stung by a Bee?

Does camper experience any of the following physical or behavioral conditions that may require medications, special considerations, or modifications during the week of camp? ?

If applicable, please provide more information about above listed conditions

Does Camper Know How to Swim?

Does Camper Take Prescribed or Scheduled Over the Counter Medications?

Please list medication name, dosage, time(s) of day for administration, and reason for medication. All medications will need to be turned in to the Camp Nurse and will be administered by the Nurse throughout the week of camp. Medications will be reviewed at camper check in.

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

Date of Last Tetanus Shot or Booster

Permissions & Acknowledgements

Please Open and Review the Himmelbjerget Code of Conduct with your camper (reccomended to right click and open in new tab to ensure information entered above is not lost)

Code of Conduct Agreement: I certify that I have discussed all the policies, including their meanings and consequences, with my child, and they agree to abide by Himmelbjerget's expectations for a safe and harrassment-free week of camp.

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.

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.

Tuition & Fees

Review this breakdown to determine your camper’s tuition costs for 2025

Select the Discounts that Apply

NWDA Member
Early Bird (Register by March 31st)

Will You Be Paying for an Alternative Diet? (+$60)

Total Dollar Amount to be Paid to Himmelbjerget

Tuition will be paid through a separate secure link through the Northwest Danish Association (found on the “tuition & more” tab or in your confirmation email)

Is Camper Applying for Tuition Scholarships? If yes, from where?

2025 Camper Registration

Camper Information

Parent/Guardian Information

Emergency Contact

Health & Medical Information

Permissions & Acknowledgements

Tuition & Fees