Summer Camp Fillable Forms

SM&NC Summer Camp Forms

Read Receipt & Agreement(Required)

January 2024

Dear Parent,

Welcome to the SM&NC Summer Camp! Thank you for choosing the Stamford Museum & Nature Center for your child’s summer camp experience. We are excited about another fun summer and know that you and your child will be too! As you may know, we are a summer camp licensed and inspected by the State of Connecticut and thus, must follow any protocols set in place by the CT Department of Health. For COVID, this means that all of our staff are required to be vaccinated except in cases of a medical exception. It will also mean that we will be required to follow any new mandates about vaccines in regard to potential campers and will do our best to communicate any changes to parents as quickly as possible.

It has been, and will continue to be this year, our policy that ALL campers must have their complete paperwork on file a week before their first day of camp. This allows us to prepare Individual Care Plans for campers that need them, to be sure that staff are well-prepared for campers, and allow for adequate time for roster creation. Campers that do not meet this requirement will not be allowed to attend camp and refunds or credits will not be offered for any missed time. Please note that we also are no longer able to accept forms via fax, as they are often challenging to read. To ensure your child’s full time at camp, please plan ahead with your forms.

For medical forms, it is important to note that we can accept a valid medical record dating back three years from the date of your child’s last day of camp. If your child attended our summer camp or our Art, Nature & Me Preschool we can also use last year’s medical form, if you wish, provided it is still valid.

For each camper you will need the following required documents to read, complete, and return a minimum of ONE WEEK BEFORE YOUR CHILD’S FIRST DAY OF CAMP:

• Online Summer Camp Forms (this online form which includes: Participant Contact Information Form, Medical History, Liability Release Form, and optional Photo Release Form)

• Physician’s Examination Form (dated within the last three years & signed by doctor)

• Allergy Forms (ONLY if your child has a life-threatening allergy)

If your child has any documented life-threatening allergies, medication forms are required and must be filled out by your child’s physician. Links to all camps forms are available on our website here. Camper information forms can be filled out online and e-mailed to our camp e-mail: summercamp@stamfordmuseum.org. Medical and allergy forms can be scanned and e-mailed or can be mailed to or dropped off at the museum.

Please note that forms are not necessary for Junior Curator or Junior WILD! Keepers unless your child has an allergy that requires medication to be on-hand during the program. Forms are also not necessary for our Wonder Art classes.

Also, since most camp communication is done through e-mail, a valid e-mail address is required both for registration and on camp forms. Please check the e-mail in our system when registering to make sure it is valid and still in use!

Please contact us with any questions or concerns. We look forward to seeing your child at camp!

Sincerely,
Lisa Monachelli
Director of Education & Summer Camp Director

I have read the following and understand that this and all forms must be submitted to the SM&NC no less than one week before the start of my child’s first day of camp.

Participant Contact Information

Child's Name(Required)

First Last

Gender(Required)

Date of Birth(Required)

Camp

Wild at Art

Earthkeepers

Heckscher Farmers

Explorers Adventure

BioDiscovery Science

Child's First Camp Day

Parent/Guardian or Other Person Registering the Child(Required)

First Last

Relation to Child(Required)

Cell Phone(Required)

Preferred Phone?

Home Phone

Preferred Phone?

Email(Required)

Address(Required)

Street Address Address Line 2 City State Zip Code

Is there a second Parent/Guardian Contact you'd like to add?

Yes

Parent/Guardian or Other Person Registering the Child

First Last

Relation to Child

Cell Phone

Preferred Phone?

Home Phone

Preferred Phone?

Address

Same as previous

Street Address Address Line 2 City State Zip Code

Emergency Contact Information

Contacts in case the parent or guardian is unavailable. In addition, the emergency contacts are permitted to drop off and pick up your children. Parents/guardians above do not need to be listed here.

Emergency Contact:(Required)

First Last

Relation to Child(Required)

Cell Phone(Required)

Preferred Phone?

Home Phone

Preferred Phone?

Address(Required)

Same as previous

Street Address Address Line 2 City State Zip Code

Is there a second Emergency Contact you'd like to add?

Yes

Emergency Contact:

First Last

Relation to Child

Cell Phone

Preferred Phone?

Home Phone

Preferred Phone?

Address

Same as previous

Street Address Address Line 2 City State Zip Code

Pick Up/Drop Off Authorization

In addition to the registering parent(s) and emergency contacts, the following people are permitted to drop off or pick up my child. Parents/guardians and emergency contacts do not have to be listed again.

No Additional Pick Up

No additional Pick Up/ Drop In Authorizations

Name

First Last

Relation to Child

Cell Phone

Preferred Phone?

Home Phone

Preferred Phone?

Is there a second person you'd like to authorize for Pick Up & Drop Off?

Yes

Name

First Last

Relation to Child

Cell Phone

Preferred Phone?

Home Phone

Preferred Phone?

Doctor & Insurance Information

Family Physician(Required)

Prefix First Last

Phone(Required)

Do you carry Medical/Hospital Health Insurance?(Required)

Yes

Medical/Hospital Health Insurance Carrier

Policy or Group #

Phone

Family Dentist/Orthodontist(Required)

Prefix First Last

Phone(Required)

Do you carry Dental Insurance?(Required)

Yes (Different Carrier as Medical)

Yes (Same Carrier as Medical)

Dental Insurance Carrier

Policy or Group #

Phone

Medical History

IMPORTANT: Please notify the camp if this camper is exposed to any communicable diseases during the three weeks prior to camp. If you feel you do not have enough current information to fill out this form accurately, please contact your physician.

Documented Life-Threatening Allergies* (*if yes, further forms are necessary)(Required)

Yes

Carries Epi-Pen

Please Download our Allergy Form here (form will open in new window)

Asthma(Required)

Yes

Uses Inhaler

Uses Oral

Seizure Disorder(Required)

Yes

Contact Lenses(Required)

Yes

Frequent Ear Infections(Required)

Yes

Recent exposure to contagious diseases(Required)

Yes

Disease

Heart defect/disease(Required)

Yes

Diabetes(Required)

Yes

Bleeding/Clotting Disorder(Required)

Yes

Other Allergic Reactions (hay, milk, etc.)(Required)

Yes

Other Allergic Reactions: Please Elaborate

Are there any activities to be restricted?(Required)

Yes

Please Elaborate on Activity Restrictions

Operations or Serious Injuries(Required)

Yes

Please Elaborate and specify dates

Socialization or Behavioral Issues(Required)

Yes

Please Elaborate on Socialization or Behavioral Issues

Has your child contracted COVID-19?(Required)

Yes

Has your child been vaccinated for COVID-19?(Required)

Yes

Release of Liability for Child's Participation in Program

Children's Photograph Release

This consent is optional and parents may choose not to consent/submit

Camp Quick Links

Registration information
Summer Camp FAQs
2023 Allergy Forms: Download PDF
2023 Physician Form: Download PDF

If you have questions about your online registration or membership account, please contact registration at 203.977.6521.

Questions about camp protocols and content may be directed to the Camp Director at summercamp@stamfordmuseum.org.

SM&NC Summer Camp Forms

Participant Contact Information

Emergency Contact Information

Pick Up/Drop Off Authorization

Doctor & Insurance Information

Medical History

Release of Liability for Child's Participation in Program

Children's Photograph Release

Camp Quick Links

Contact Us

Stamford Museum & Nature Center

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