2024 Capen Hill Science and Nature Camp Registration Form

"*" indicates required fields

Child's Name*
Age at Start of Camp*
Grade in September
Please list as whole numbers.
Parent 1
Parent 2
Mailing Address*
Contact Email Address*
Please include your e-mail address. Thank You
Emergency Contact*
Before your child starts camp, we need a copy of his/her immunization record. Form may be mailed to Capen Hill Nature Sanctuary, P.O. Box 218, Charlton City, MA 01508 or emailed to barbhfrederick@gmail.com. You may also upload immunization record below.
Max. file size: 256 MB.
Please upload a copy of your child’s immunization record if you have not sent it in. Thanks
Does your child need medication at camp. If yes we will email you a form
Doctor's Name*
Please check session or sessions for your child.
Price: $225.00
Camp T -Shirts $25 Each
Price: $25.00
Price: $20.00
One size fits all.
If you would like your child to be placed with friends or siblings of same approximate age, please write information pertaining to this in the box. It helps us out now then to try to place friends together when groups are already designated. If we have a question, we also will contact you. Thanks for your cooperation.
Parental Permission Waiver*
I hereby authorize the staff of Capen Hill Nature Sanctuary to act for me in accordance with their best judgement in any emergency requiring medical attention. I understand that the director of the camp may, if necessary for my child’s health, have him/her hospitalized or use outside medical, surgical or dental care. I hereby waive and release Capen Hill Nature Sanctuary for expenses incurred due to sick illness or accidental injury sustained while participating in camp activities. I also understand that the director and/or camp leaders may dismiss my child from Capen Hill Nature Camp, if, in their opinion his/her conduct or influence is not in the best interest of the entire group. No refund is given if such action is taken for discipline reasons.
Choice One is Paypal or Credit Card. Credit card payment is under the Paypal Login. Choice 2 is Send a Check