2019 SUMMER CAMP REGISTRATION
Monday – Friday: 8:30 am – 3:30 pm
All Camp Weeks - $325
Camp Name Session Dates Age Group
Sprouts Week 1: June 10 - 14  3 - 5 year olds 
Fantastic Forts
Week 2: June 24 - 28  6 - 10 year olds
Archery & Games Week 3: July 1 - 5 10 - 14 year olds
Wilderness Adventures
Week 4: July 8 - 12 6 - 10 year olds
WildCraft Week 5: July 15 - 19 8 - 12 year olds
Woodland Fairies & Elves
Week 6: July 22 - 26 6 - 10 year olds
Fantastic Forts Returns Week 7: July 29 - August 2 7 - 12 year olds
Wild World of Play Week 8: August 5 - 9 8 - 12 year olds
Fun in the Forest Week 9: August 12 - 16 6 - 10 year olds
Qty
Description
Amount
Total

$285.00
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$325.00
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$325.00
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$325.00
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$325.00
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$325.00
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$325.00
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$325.00
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$325.00
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Would you like to Round Up?
Total: $0.00
Future Commitment: $0.00
For wait list please contact shelby@learningoutside.org.
Please confirm which Summer Camp(s) your payment is for
Week 1: Sprouts
Week 2: Fantastic Forts Sold Out
Week 3: Archery & Games Sold Out
Week 4: Wilderness Adventures Sold Out
Week 5: WildCraft
Week 6: Woodland Fairies & Elves Sold Out
Week 7: Fantastic Forts Returns Sold Out
Week 8: Wild World of Play Sold Out
Week 9: Fun in the Forest Sold Out
Registrant Information
A complete and accurate registration provides safety for your youngster. It is the information we rely on in the event of an emergency.
(At start of session)
Write in "homeschooled" if applicable.
Parent/Guardian #1/Payer Information
This is the address where your credit card or bank statements are mailed.
A receipt will be e-mailed to this address.
Parent/Guardian #2 Information
Emergency Information
EMERGENCY contact person (if parent/guardian cannot be reached)
BACKUP CONTACT PERSON (in case primary contact cannot be reached):
Medical Contact Information
Health Information
(food, drugs, insects, plants, etc. or N/A)
(If none, enter N/A)
Has the participant been hospitalized and/or had any surgeries in the last year?
Does the participant have any chronic medical Conditions that require him/her to be under the care of a doctor? (Epilepsy, Asthma, Diabetes, Heart Condition etc.?)
Check here if you are submitting a NC Immunization Exemption Form.
Are there any social challenges, communication challenges, physical handicaps, fears/phobias or conditions that may be helpful for the Learning Outside staff to know about?
Release Statement
I hereby attest that all of the information provided above is correct and complete.

In event of injury or illness, I give the Learning Outside Staff and emergency/professional medical personnel permission to provide medical treatment for the participant listed above.
I have read the above and give permission.
Hold Harmless Agreement
Learning Outside offers outdoor learning programs on Triangle Land Conservancy’s Irvin Nature Preserve, 269 acres of pasture, forest and wetlands preserved in perpetuity by the Triangle Land Conservancy in Orange County. Program activities include art, science and other learning activities for both children and adults.

Activities in this program may include, but are not limited to: gardening, farm chores, interaction with goats, chickens and other farm animals as well as cats and/or dogs, drawing, painting, printmaking, other arts and crafts activities, nature crafts, singing, song writing, storytelling, dance, creative drama, puppet making, nature exploration, shelter building from natural materials, fire building, cooking, animal tracking, running games and other strenuous physical activity, archery, walking along the farm driveway to the pond, pond exploration and wading in the pond, hikes in the woods and to the creek, creek exploration and wading in the creek, work with woodworking hand tools and more.

Risks inherent in these activities include, but are not limited to:
  • Exposure to biting insects, ticks, poison ivy, and poisonous snakes
  • Exposure to diseases carried by ticks and other biting insects
  • Walking, hiking, running and playing in hot or otherwise inclement weather
  • Falls from climbing or slipping on pond banks, tree stumps, branches, & uneven terrain or tripping on rocks/stumps
  • Injuries from use of sharp tools for carving, whittling, gardening and/or woodworking, or glue guns and allergic reaction from exposure to paints, paper mâché paste, cement, and other art materials during arts and crafts activities
  • Burns from hot plate, camp fire, or hot food/liquids during cooking activities
  • Drowning or injury while wading or playing in natural bodies of water
  • Accidents on the driveway
  • Risks normally associated with travel in a car driven by staff, hired drivers or the parent of one of the participants

I authorize Wendy Banning, Director of Learning Outside, as well as all paid and volunteer instructors in whose care my child has been entrusted, to lead the above named child in activities of the type listed above. I understand that there are risks inherent with the activities as well as with transportation to and from each area. I nevertheless voluntarily assume all risks of loss, damage or injury that may be sustained through my child's participation in programs offered by Learning Outside.

I agree to hold Learning Outside, Wendy Banning and all other instructors, volunteers, Learning Outside Board Members, Learning Outside Employees, and hired drivers as well as the Triangle Land Conservancy harmless for injuries, loss, or damage which may occur during such activities or while being transported to and from such activity.
I have read the above and agree to all terms.
Multimedia Image Release
I hereby give permission for my child’s image to be used by Learning Outside and Wendy Banning, Learning Outside’s Director, for outdoor learning presentations, teacher training, publications, advertising and fundraising, including on the Learning Outside websites (www.learningoutside.org + www.learn-outside.com) and the Learning Outside Facebook page or the Triangle Land Conservancy website.

NOTE: For security reasons, children’s names are not used with photos in any of these places.


The registration and payment receipts are not a guarantee of enrollment. All enrollments will be confirmed by personal email from Learning Outside to the parent/guardian. If a camp week over-enrolls, a refund will be issued.
I have read the above statement.
NO REFUNDS FOR WITHDRAWALS:
I accept that there are no refunds for withdrawals.
Race/Ethnicity
The grants that Learning Outside applies for each year require that we specify the racial and ethnic backgrounds of the children enrolled in our programs. Please check all that apply.
Black
African American
Hispanic or Latino
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
White
Multi-Racial
For NEW families - How did you hear about Learning Outside?
Learning Outside’s website or Facebook page
Other online listing
Family friend/work colleague/neighbor
School flyer that came home with your child
Flyer or postcard out around town
Open House or other event at Irvin Nature Preserve
Camp Fair
Community event
Newspaper or print ad
Your Payment Information

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