Camp Kellogg Registration Camp Kellogg Registration Summer 2022 Step 1 of 4 25% Child's Name * Required Child's Age * RequiredGuardian Name(s) * Required Phone Number * RequiredBest Contact Email * Required Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code SessionsSession 1 (June 6 - 10) No choice S1: Ages 5-6 Sensory Saturation: A week of dynamic sensory play and discovery | 9 a.m. - 2 p.m. | $210 | 10 spots (0 spots remaining) S1: Ages 6-8 Edible Education - Know, Sow, Grow: Campers will explore the scientific and practical components of gardening in a week of botany study, gardening, soil science, and their pollinator friends. | M-Th 9 a.m. – 4 p.m. / F 9 a.m. – 2 p.m. | $285 | 12 spots (0 spots remaining) S1: Ages 6-8 Nature Detectives: STEM experiments for mystery solving | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 6 spots (0 spots remaining) S1: Ages 9-13 Extreme STEM Adventure Laboratory: Grab your goggles and lab coat for this week of camp! Discover the hows and whys behind some wacky, adventurous, and extreme STEM experiments | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 6 spots (0 spots remaining) S1: Ages 14-17 Leader In Training: Language of Leadership- what does it sound/look/feel like to be a good leader? | M-Th 8:45 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $150 | 4 spots (1 spot remaining) Session 2 (June 13 - 17) No choice S2: Ages 5-6 Fairy Gardens & Gnome Homes: Garden care, storytelling, nature crafts, and creative exploration | 9 a.m. - 2 p.m. | $210 | 10 spots (0 spots remaining) S2: Ages 6-8 Bushcraft & Wilderness Skills: Crafting and wilderness skills for outdoor adventures all while practicing survival safety | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 10 spots (0 spots remaining) S2: Ages 9-13 Made for the Stage: Creativity comes to life with improv, acting, set, props, and costumes, all using the great outdoors as inspiration! | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 15 spots (0 spots remaining) S2: Ages 14-17 Leader In Training: Balance in Leadership- How is a give and take environment beneficial? | M-Th 8:45 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $150 | 4 spots (2 spots remaining) Session 3 (June 20 - 24) No choice S3: Ages 5-6 Wild About Water: play meets science with water in various forms | 9 a.m. - 2 p.m. | $210 | 10 spots (0 spots remaining) S3: Ages 6-8 The Nature of Art: Using a variety of mediums, campers will be guided to create art utilizing natural and recycled materials for a full sensory art experience, nurturing their connection to nature. | M-Th 9 a.m. – 4 p.m. / F 9 a.m. – 2 p.m. | $285 | 12 spots (0 spots remaining) S3: Ages 6-8 Fairy Gardens & Gnome Homes: soil science, storytelling, and nature crafts | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 12 spots (0 spots remaining) S3: Ages 8-13 Spring Creek Farm Experience: Get out your garden gloves and jump into a week with the Spring Creek Farm crew to experience the process from seed to farmstand on our 2-acre Alaskan grown vegetable farm. | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 12 spots (0 spots remaining) S3: Ages 9-13 Bushcraft & Wilderness Skills: Crafting and wilderness skills for outdoor adventures all while practicing survival safety | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 12 spots (0 spots remaining) S3: Ages 14-17 Leader In Training: Everlasting Experiences: When does a leader stop learning? | M-Th 8:45 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $150 | 4 spots (3 spots remaining) Session 4 (June 27 - July 1) No choice S4: Ages 5-6 Micro Madness: a focus on soil science, invertebrates, insects, anything under a microscope | 9 a.m. - 2 p.m. | $210 | 10 spots (0 spots remaining) S4: Ages 6-8 Fairy Made for the Stage: Creativity comes to life with improv, acting, set, props, and costumes, all using the great outdoors as inspiration! | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 12 spots (0 spots remaining) S4: Ages 9-13 Battle of the Big 5: A week of challenges of body, mind, and creativity: orienteering, wayfinding, puzzles, obstacle courses, and so many games! | M-Th 9 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $285 | 15 spots (0 spots remaining) S4: Ages 14-17 Leader In Training: Leader in Training- The How of Camp Kellogg: What happens at camp before the campers arrive? | M-Th 8:45 a.m. - 4 p.m. / F 9 a.m. - 2 p.m. | $150 | 4 spots (2 spots remaining) Total $0.00 Camper T-shirt Size (included with camp cost) * Required Youth XS Youth S Youth M Youth L XS S M L XL Additional Friends & Family T-shirts ($15 each)Youth XS Price: $15.00 Quantity: Youth S Price: $15.00 Quantity: Youth M Price: $15.00 Quantity: Youth L Price: $15.00 Quantity: XS Price: $15.00 Quantity: S Price: $15.00 Quantity: M Price: $15.00 Quantity: L Price: $15.00 Quantity: XL Price: $15.00 Quantity: XXL Price: $15.00 Quantity: Total $0.00 Cancellation and Refund Policy * Required• There is a non-refundable $50 deposit, per camper, per week of registered camp. The deposit is applied to the camp cost. • If you cancel two or more weeks prior to camp, you will receive a 100% refund (less the non-refundable $50 deposit) • If you cancel within two weeks of the camp start date, you are responsible for 50% of the total camp cost if we are unable to fill the spot. • If you withdraw from camp after the start date, there is no refund. • The camp cost must be paid in full two weeks prior to the start date. I understand and agree. Emergency Contact Name * Required Emergency Contact Relationship * Required Emergency Contact Phone Number(s) * Required Does your student have allergies to any of the following? * RequiredSelect all that apply Insect Bites/Stings Foods Environmental Medicines No Known Allergies Other (specify below) If you indicated yes to any of the above, please provide detail about the allergy, its severity, and its management. * RequiredDoes your student have a history of any of the following conditions? * RequiredSelect all that apply Heart Defect/Disease Diabetes Hypertension Epilepsy Bleeding/Clotting Disorders Asthma Mental/Emotional Illness Skin Conditions No Known Medical Conditions Other (specify below) If you indicated yes to any of the above medical conditions, please provide greater detail about the condition, its severity, and its management. * RequiredIs your student currently taking any prescription medications? If yes, please provide relevant information. * Required Is there any important health information that we missed? COVID Protocol & Procedures * RequiredWe currently do not require masks while participating in activities on APU's campus. Wearing a mask is optional for all participants. If there is any change to this policy, all registrants will be given timely notice. I understand and agree Photo Release * RequiredI grant Alaska Pacific University and its representatives and employees the right to take photographs of my child and his/her property in connection with Camp Kellogg programming. I authorize Camp Kellogg, its assigns and transferees to copyright, use and publish the photographs in print and/or electronically. I agree that Camp Kellogg may use such photographs of my child with or without his/her name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and/or web content. I agree I do not agree Consent for Emergency Medical or Surgical Care * RequiredIn the rare event of an emergency, I hereby give my permission to the medical personnel selected by the program director to provide routine health care; to administer medications; to order x-rays, routine tests, treatment; to release any record necessary to insurance purposes; and to provide or arrange necessary related transportation for me/my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the program director to secure and administer treatment, including hospitalization, for the person named above. This form may be photocopied for trips away from campus. All information is strictly confidential. Camp Kellogg does not cover accident insurance coverage for participants; you must carry your own accident insurance coverage. I authorize the above information for insurance purposes. It is understood that a conscientious effort will be made to locate me or my child's other legal guardian. I understand my obligation to keep Camp Kellogg informed of my whereabouts. I will assume the cost of necessary medical or surgical care. I agree I do not agree Authorization to Participate * RequiredMy son/daughter/dependent has permission to participate in all Camp Kellogg activities. I recognize that my child will be participating in active, outdoor programs with other children and that accidental injuries and illnesses may result. I assume the inherent risks of, but not limited to, the following: running, hiking, skiing, snow shoeing, ice skating, dog mushing, group games, wildlife, and inclement weather, and authorize my child's participation. Camp Kellogg instructors do not provide transportation to participants. I understand that I am responsible for transporting my child to any activity occurring off-site. If I am unable to attend, it is my responsibility to arrange a ride-share with another parent or guardian. Camp Kellogg is hereby released from all claims, liability, and losses for actions taken in good faith during this program. I agree I HAVE READ ALL QUESTIONS INCLUDED IN THIS FORM THOROUGHLY, AGREE TO ITS TERMS AND I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE AND COMPLETED TO THE BEST OF MY KNOWLEDGE. * RequiredIf you agree to the above statement, please type your name in the box below. Total $0.00 Credit Card * Required American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Δ
