WildNative Eco Camp Registration – Ph: 844-900-CAMP

WildNative Eco Camp Logo
WildNative E.C.O. Camp is for high school students Ages 13 – 18 who are interested in Marine Biology, Ecology, Zoology, or who just love to be outside and learn about the environment! Join us this summer for an Exciting Coastal Opportunity in either our Residential or Day Camp, and have a “water-ful” good time at Wild Native E.C.O. camp!

WildNative Eco Camp Registration Form

2016 Dates:

June 5 – 11: Day Camp
June 12 – 18: Day Camp
June 19 – 25: Residential Camp
June 26 – 2 July: Residential Camp

2017 Dates:

June 4 – 10: Day Camp
June 11 – 17: Day Camp
June 18 – 24: Residential Camp
June 25 – 1 July: Residential Camp

Please fill out the following information as completely as possible:

Please complete the following about the Camper:

Camper Name:

Nickname:

Full Address (City, State & Zip):

Phone:

Gender:

Birthdate:

Grade entering Fall 2016:

Please complete the following about the first parent/guardian:

Parent Name:

Relationship to Camper:

Cell Phone:

Work/Other Phone:

Email:

Full Address (City, State & Zip) - If different from Camper:

Please complete the following about the second parent/guardian:

Parent Name:

Relationship to Camper:

Cell Phone:

Work/Other Phone:

Email:

Full Address (City, State & Zip) - If different from Camper:

Please note, WildNative Camps want to provide your camper with a fantastic experience. To help in this process providing as much information about your camper’s immediate family, contact information, and personal life is mostly helpful to welcoming the camper into this program. If there are any other family members (siblings, grandparents, etc.) that are closely involved in your child’s life please include the information in the space below.

Emergency / Medical Information:

In the unlikely case of an emergency, who should we contact first?:

Does the camper have a primary physician?:

Name and number of primary physician:

If you have any hospital preferences please indicate them here:

Please list all known allergies your child has (and any medication they carry for these):

Please list all medications (incl. vitamins) that your child takes regularly:

Please tell us about your child’s dietary restrictions and/or preferences:

Other Information:

On a scale of sink-like-a-rock to Michael Phelps how well can your camper swim?:

What is your camper’s favorite movie?:

Where has your camper traveled before this camp?

If your camper could have a super power, what would it be and what would be done with it?

What is your camper most excited about for this camp?:

Any final requests or other information we should know about your child?:

Thank you for your information and registration. An ECO Camp counsellor will be in touch shortly. We look forward to seeing your child soon at WildNative ECO Camp!