Bilingual Youth Summer Camp Registration Form

<< Back to Previous Page

Contact Information

First Name: Last Name:

Email:

 

Student Information

First Name: Last Name:

School: Grade as of Fall 2014: Date of Birth:

First Name: Last Name:

School: Grade as of Fall 2014:  Date of Birth:

First Name: Last Name:

School: Grade as of Fall 2014:  Date of Birth:

 

Parent/Guardian Information

First Name: Last Name:

Address: City:

State: Zip:

Home Phone: Work Phone: Cell Phone:

Relationship to Student:

 

First Name: Last Name:

Address: City:

State: Zip:

Home Phone: Work Phone: Cell Phone:

Relationship to Student:

 

Adults authorized to pick child up from camp (other than listed above):

Name:  Phones: 

Name:  Phones: 

 

Emergency Contacts (other than parents listed above):

Name:  Phones: 
Relationship to youth: 

Name:  Phones: 
Relationship to youth: 

Medical Information: 

 Allergies, medications, diet restrictions.

This information is confidential and will not be shared with anyone other than your child's camp instructor.

Payment Due
You may pay with a check by mail to the address listed below or pay by card in person or over the phone.

$160 General
$140 MNCH Member

Museum of Natural and Cultural History members receive discounts on programs throughout the year, including summer camp, after-school and weekend clubs as well as free admission to exhibits all year.

Family discount: 10% discount for two or more children 

Family discount: There is a 10% discount for two or more children attending the summer camp.

Cancellation Policy:
Up to 14 days prior to start of camp - 80% of fees will be refunded
Up to 5 days prior to start of camp - 50% of fees will be refunded
Cancellations made after the Thursday prior to the start of the session will not be refunded

Your registration is not finished until you complete the steps below:

In addition to filling out and submitting the form above, you will need to download, sign, and submit a Release of Liability and Emergency Medical Care and a Media Authorization and a Behavior Contract.

You may either mail or drop off the permission form with your payment to 1680 East 15th Ave., Eugene, OR 97403-1224.

Questions or payment by phone at (541) 346-1694 or in person, 9 a.m.-5 p.m. Monday through Friday