Camp Registration Form

Child's First & Last Name
Age (during camp session)
Grade (highest completed)
Gender
Parent/Guardian's Name
Home Phone
Work Phone
Email
Cell/Pager #
 I would like to receive Museum News via e-mail
Address
City
State
Zip

Does this child:

…have any medical problems?
Explain:

…take medications regularly?
Explain:

…have any allergies—food or otherwise?
Explain:

…have dietary, behavior, educational challenges, other concerns?
Explain:

Family doctor
Clinic Name and/or Phone #
Emergency Contact Name
(NOT a parent; another relative/friend/neighbor, etc. in case parent are unreachable)
Emergency Contact Phone


Does this child have custodial concerns regarding who can pick him/her up from camp?

I hereby give full consent to the City of Greeley Museums to copyright and/or publish all photographs taken of my enrolled son/daughter/ward, and I agree all photos, including artwork and projects, may be used for public display, publication, and advertising purposes without limitations or compensation. I understand that while my child participates in Museum classes, he/she will participate at his/her own risk. I also agree to hereby release and forever discharge the City of Greeley, Leisure Services Department, Museums Division thereof and its officers, agents, or employees from or in any manner arising out of any injury or damage which the above registered person may sustain in the aforementioned program. I also authorize the City of Greeley and/or staff the authority to provide emergency care in case of an accident. I will read the registration information/rules sheet given to me upon registration and discuss them with my child.
Parent/guardian's signature required by first day of camp

CAMP REGISTRATION BEGINS TUESDAY, APRIL 7th, 2009 AND IS ON-GOING AFTER THAT DATE.

Camps Under the Cottonwoods
$70 per week
Monday-Friday 8:30am-12:30pm
@ Plumb Farm Learning Center
955 39th Ave.


 June 8-12 Short Chefs Mind Their Manners (PF1)
June 15-19 Short Chefs Mind Their Manners (PF2)
June 22-26 Past Blasters: Magic Treehouse (PF3)
July 13-17 Past Blasters: Magic Treehouse (PF4)
July 20-24 ArtFarm: Critter Creations (PF5)
July 27-31 ArtFarm: Critter Creations (PF6)


Lone Valley School Camps
$60 per week
Monday-Friday 8:30am-12:30pm
@ Centennial Village Museum
1475 A St.

June 8-12 Farmer Boys & Prairie Girls (LVS1)
June 15-19 Bubblegum 'n' Bobbysoxers (LVS2)
June 22-26 City Cousin, Country Cousin (LVS3)
July 13-17 Farmer Boys & Prairie Girls (LVS4)
July 20-24 Bubblegum 'n' Bobbysoxers (LVS5)
July 27-31 City Cousin, Country Cousin (LVS6)

Camps Under the Cottonwoods
number of sessions:
@ $70 each


Lone Valley School Camps
number of sessions:
@ $60 each

$ Total for Plumb Farm Camp
$ Total for Centennial Village

$ Camp totals
$ MINUS discount

10% discount because I have a Friends of the Greeley Museums Family Membership
$10 off per class because my child is an Aide in Training
$10 off because of a special event Prize Coupon

Only ONE of the above discounts may be applied at time of enrollment.

$ GRAND TOTAL

As soon as this form is received, you will be contacted by a Museums staff member concerning payment options. We accept cash, checks, VISA and MasterCard payments.

Refund policy
Full refund three (3) or more days before class begins
50% refund two (2) or fewer days before camp begins
NO refund once camp begins unless special circumstances apply.
All requests for refunds must be in writing to the Museums Superintendent.
If a camp is canceled due to low enrollment or a Museums emergency, a full refund is available.

One session change is FREE; $10 charged for each change after the first. Please notify us as soon as possible of any camp change needs.