Summer Adventure Camp 2025

Camper's Name *

First

Last

Camper's Sex *

Camper's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Age of Camper *

Entering Grade (Choose One) *

Phone *

Emergency Phone

List Allergies or Medical Conditions if needed

List Medications if needed

Risk Grade Name

Parent/Guardian Information *

First

Last

Relationship *

Email *

Acknowledgement of Risk & Release – All Boxes Must Be Checked *

Privacy Policy – Pelican Island Audubon Society will not release any information regarding your child/guardian to any third party under any circumstances with the exception being appropriate medical persons during a medical situation.
Publicity Release – I give permission for any images, likenesses or quotes taken of my child/guardian to be used for Pelican Island Audubon for publicity purposes, including but not limited to newsletters, social media, presentations and websites.
Liability Release -I have voluntarily requested that my child/guardian be placed in a science nature activity program with Pelican Island Audubon. I am not giving up my right to justice in the case of negligence but rather am acknowledging that a Pelican Island Audubon camp program environment can have dangers both seen and unforeseen that may be out of control of the program. In these situations, I will hold harmless of any liability Pelican Island Audubon Society, its officers, agents, employees or volunteers.
By checking this box, you acknowledge acceptance of this camp application for your child and enrollment after payment payment is received.

Choose one option below (aftercare from 3PM -4:30pm is an additional $75): *

PayPal Commerce (Use dropdown menu to select Credit Card) *

Card Number

Expiration Date

Security Code

Card Holder Name

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