Spring Break Camp Form

Guardian Name *

Relation to Camper

Cell Phone for emergencies *

Email Address *

Address

Would you like to list an additional guardian? *
YesNo

Guardian #2 Name

Guardian #2 Phone

Guardian #2 Email Address

Guardian #2 relation to Camper

Camper Information (Name, Age, Pronouns) *

Camper Information #2 (Name, Age, Pronouns)

Camper Information #3 (Name, Age, Pronouns)

Camper's address during camp week*

Has your child attended Hunter Camp before?
YesNo

Please list any learning or behavioral support your camper may need (headphones, frequent breaks, focus check ins, etc)

Describe the learning environment your camper thrives in (examples: high energy and movement, quiet small groups, needs frequent breaks, etc)

Tell us an activity your camper enjoys

Physicians name and phone number *

Will your camper be taking medication during camp? *
YesNo

If so, list medications and times/regulations for administering child's medications

Please share any camper's conditions or health considerations that you feel are important for camp staff to know

Please list any allergies camp staff should be aware of

Does your child carry an inhaler?
YesNo

Will you be sending your child with an Epi-Pen that you would like to give camp staff permission to administer if necessary?
YesNo

Approved Pick up List for camper *

Is there anyone who DOES NOT have permission to pick up the camper? If so please list below

I consent to the use of images of my camper(s) by the Hunter Museum of American Art. *
YesNo

By clicking this box below, you agree to having your camper(s) dropped off no later than 9am and picked up by 4pm each day of camp. Failure to do so may result in late fees. The Hunter does not provide before or after care at camp. *
I agree

Please type your name below as signature. *

Please type todays date below to date your authorization. *