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Registration Form

Welcome! Let's get you registered! 

**We recommend that you use Firefox or Chrome to complete your online registration. Please do not use Safari and please do not register on your phone, as we are still working out technical difficulties with our mobile interface. If you don't have Firefox, you can download it for free here.

If you wish to apply for Financial Assistance, please register and apply here. Deadline for Financial Assistance applications for Summer Camp 2017 is Saturday, May 20.

Here's what you'll need to have on hand as you begin:

  • If you are registering a child, a digital copy of their most recent immunization record to upload if they are immunized. If they are not immunized, you will have the option to indicate that.
  • Name and number of your/your child's physican
  • Insurance company name and policy number
  • Credit card or Paypal account to make full payment.

Please note that individual registration forms must be submitted for each child.

Great news! Once you complete this form, you can register for multiple programs within the same year without doing the entire process again. However, health and registration forms must be renewed each calendar year.  

Cottonwood Camp Discount: You receive a 10 percent discount when you register two or more children for Cottonwood Camp, or when you register one child for two or more weeks of Cottonwood Camp. The discount will be automatically applied when you check out.

Cancellation Policy: If you cancel at least two weeks prior to the first day of a program, you will receive a full tuition refund minus a $25 processing fee. No refunds will be given for cancellations less than two weeks before the first day of the program.

If you would like to register by snail mail, download forms.

Select One or More Programs for This Participant:

First and last name.
Details
[At time of camp or program.]
[or homeschooling?]
[For summer camp, the grade your child is entering this fall.]
If you would like to be placed in a clan with a friend of the same age who is or might be attending this camp/program, please write the friend’s name here. Please note that we cannot guarantee that you will be in the same clan, but we’ll do our best!
For Overnight Camps/Programs Only
Please tell us about your relevant experience and skills (such as camping, survival skills, backpacking, or canoeing) and why you want to attend this camp or program.
Details
Address
City
State
Zip Code
Parent/Guardian 1
Address
City
State
Zip Code
Parent/Guardian 2
Address
City
State
Zip Code
Emergency Contact 1

[OTHER THAN PARENT]

Emergency Contact 2

[OTHER THAN PARENT]

Parent/Guardian Information
Parent/Guardian 1
Address
City
State
Zip Code
Parent/Guardian 2
Address
City
State
Zip Code
Update Emergency Contact 1

[OTHER THAN PARENT]

Update Emergency Contact 2

[OTHER THAN PARENT]

Emergency Contact 1
Emergency Contact 2
Address
City
State
Zip Code
Emergency Contacts

[OTHER THAN PARENT]

Update Emergency Contact 2

[OTHER THAN PARENT]

Health Form

Health forms must be updated each calendar year. It is your responsibility to let us know of any relevant changes that might occur after you have submitted this form.

Are there any medical conditions we need to know about for your child's safety and well-being?
Physician Information
Health Insurance Information
Hospital Information
Emergency Permission

In case of emergency, I understand that every effort will be made to reach the participant’s parents/guardians or emergency contacts if parents/guardians are not reachable. In the event they cannot be reached, I hereby give my permission to the trained adult leader in charge to provide first aid and secure proper treatment. I voluntarily consent to the rendering of care by authorized members of the hospital staff or their designees, including hospitalization, anesthesia, surgery, or injections of medication for the participant.

I give permission as detailed above.

[please type full name]
Vaccination Record

Please give us a COMPLETE record of the participant’s immunization history in ONE of the following ways:

1.  Attach a form.

Files must be less than 2 MB.
Allowed file types: jpg jpeg pdf.

2.  Fill in a DATE OF VACCINATION for each vaccine listed below.

3. Type “I HAVE NOT IMMUNIZED FOR RELIGIOUS OR MEDICAL REASONS” in the box below and type "R/M" in the blank next to the vaccine(s).

"I have not immunized for religious or medical reasons."
[First administered after 12 months of age and second administered after 15 months of age.]
[administered after 12 months of age]
[Administered after 12 months of age.]
[For children born on or after January 1, 1998.]
Health Form

Health forms must be updated each calendar year. It is your responsibility to let us know of any relevant changes that might occur after you have submitted this form.

Are there any medical conditions we need to know about for your safety and well-being?
Physician Information
Health Insurance Information
Hospital Information
Emergency Permission

I hereby give my permission to the trained adult leader in charge to provide first aid and secure proper treatment. I voluntarily consent to the rendering of care by authorized members of the hospital staff or their designees, including hospitalization, anesthesia, surgery, or injections of medication for the participant.

I give permission as detailed above.

[please type full name]
Update Health Form

Health forms must be updated each calendar year. It is your responsibility to let us know of any relevant changes that might occur after you have submitted this form.

Are there any medical conditions we need to know about for your child's safety and well-being?
Physician Information
Health Insurance Information
Hospital Information
Emergency Permission

In case of emergency, I understand that every effort will be made to reach the participant’s parents/guardians or emergency contacts if parents/guardians are not reachable. In the event they cannot be reached, I hereby give my permission to the trained adult leader in charge to provide first aid and secure proper treatment. I voluntarily consent to the rendering of care by authorized members of the hospital staff or their designees, including hospitalization, anesthesia, surgery, or injections of medication for the participant.

I give permission as detailed above.

[please type full name]
Vaccination Record
Please give us a COMPLETE record of the participant’s immunization history in ONE of the following two ways:

Please give us a COMPLETE record of the participant’s immunization history in ONE of the following ways:

1.  Attach a form.

Files must be less than 2 MB.
Allowed file types: jpg jpeg pdf.

2.  Fill in a DATE OF VACCINATION for each vaccine listed below.

3. Type “I HAVE NOT IMMUNIZED FOR RELGIOUS OR MEDICAL REASONS" in the box below and type "R/M" in the blank next to the vaccine(s).

"I have not immunized for religious or medical reasons."
[First administered after 12 months of age and second administered after 15 months of age.]
[administered after 12 months of age]
[Administered after 12 months of age.]
[For children born on or after January 1, 1998.]
Update Health Form

Health forms must be updated each calendar year. It is your responsibility to let us know of any relevant changes that might occur after you have submitted this form.

Are there any medical conditions we need to know about for your child's safety and well-being?
Physician Information
Health Insurance Information
Hospital Information
Emergency Permission

I hereby give my permission to the trained adult leader in charge to provide first aid and secure proper treatment. I voluntarily consent to the rendering of care by authorized members of the hospital staff or their designees, including hospitalization, anesthesia, surgery, or injections of medication for the participant.

I give permission as detailed above.

[please type full name]
Policies and Procedures
Please list all adults who have permission to pick up your child from camp, including yourself (you may add more later).

Cancellation Policy

If you cancel at least two weeks prior to the first day of a program, you will receive a full tuition refund minus a $25 processing fee. No refunds will be given for cancellations less than two weeks before the first day of the program.

Photography Permission

We sometimes photograph our programs for use in promotional materials, and may occasionally allow media outlets to photograph our programs for publication in newspapers and magazines or online. By registering for a program, you give permission for your child's photograph to be included in Flying Deer Nature Center promotional materials.

Please initial here if you do NOT want your child to be photographed.

I certify that I have read and understand the above policies and procedures. 

[Please type full name.]
Policies and Procedures

Cancellation Policy

If you cancel at least two weeks prior to the first day of a program, you will receive a full tuition refund minus a $25 processing fee. No refunds will be given for cancellations less than two weeks before the first day of the program.

Photography Permission

We sometimes photograph our camps for use in promotional materials, and may occasionally allow media outlets to photograph our camps for publication in newspapers and magazines or online. By registering for camp, you give permission for your photograph to be included in Flying Deer Nature Center promotional materials.

Please initial here if you do NOT want to be photographed.

I certify that I have read and understand the above policies and procedures. 

[Please type full name.]
Release

Informed Consent, Release, Indemnification, and Hold Harmless Agreement

I understand that outdoor activities entail known and unanticipated risks and that participation in Flying Deer Nature Center Programs involves a certain degree of risk that could result in injury, paralysis, death, or damage to my child or to property. In consideration of the benefits to be derived and after carefully considering the risk involved, and in view of the fact that precautions will be taken to ensure the safety and well-being of all participants to the best ability of trained staff members, I agree and promise to accept and assume all of the risks existing in this activity. My child’s participation in Flying Deer Nature Center programs is purely voluntary, and I elect to participate in spite of the risks. 

I hereby release and waive any and all claims that I may have against the Sufi Order International (SOI), the Abode of the Message, Inc. (the Abode), and Flying Deer Nature Center, Inc. (FDNC), and their employees, agents, representatives, or volunteers, arising from my child’s participation in Flying Deer Nature Center Programs. I agree to fully indemnify and hold harmless SOI, the Abode, or FDNC, Inc. and their employees, agents, representatives, and volunteers from any and all claims arising from my child’s participation in FDNC programs. This indemnification expressly includes any claims arising out of the SOI, the Abode, or FDNC’s own negligence or fault or that of their employees, agents, representatives, or volunteers. I agree that the indemnification includes the amount of the claims, the expense of defending against the claims, court costs, and attorney fees. 

In consideration of my child, a minor, being permitted to participate in its activities and to use its equipment and facilities, I agree to further indemnify and hold harmless FDNC from any and all claims, as stated above, which are brought by or on behalf of Minor, and which are in any way connected with such use or participation by Minor. 

I have had sufficient opportunity to read this entire policy.  I have read and understood it, and, by typing my full name below, I agree to be bound by its terms.

[Please type full name.]
Release

Informed Consent, Release, Indemnification, and Hold Harmless Agreement

I understand that outdoor activities entail known and unanticipated risks and that participation in Flying Deer Nature Center Programs involves a certain degree of risk that could result in injury, paralysis, death, or damage to myself or to property. In consideration of the benefits to be derived and after carefully considering the risk involved, and in view of the fact that precautions will be taken to ensure the safety and well-being of all participants to the best ability of trained staff members, I agree and promise to accept and assume all of the risks existing in this activity. My participation in Flying Deer Nature Center programs is purely voluntary, and I elect to participate in spite of the risks.

I hereby release and waive any and all claims that I may have against the Sufi Order International (SOI), the Abode of the Message, Inc. (the Abode), and Flying Deer Nature Center, Inc. (FDNC), and their employees, agents, representatives, or volunteers, arising from participation in Flying Deer Nature Center Programs. I agree to fully indemnify and hold harmless SOI, the Abode, or FDNC, Inc. and their employees, agents, representatives, and volunteers from any and all claims arising from my participation in FDNC programs. This indemnification expressly includes any claims arising out of the SOI, the Abode, or FDNC’s own negligence or fault or that of their employees, agents, representatives, or volunteers. I agree that the indemnification includes the amount of the claims, the expense of defending against the claims, court costs, and attorney fees.

I have had sufficient opportunity to read this entire policy. I have read and understood it, and, by typing my full name below, I agree to be bound by its terms.

[Please type full name.]
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