Peaks and Bounds Registration Form 
Camp and Group Services (Minors)
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Which service are you registering for? *
First Name of Participant *
Last Name of Participant *
Participant DOB *
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Pronouns 
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First Name of Parent/Guardian *
Last Name of Parent/Guardian  *
Phone number  *
Email address  *
Street Address 
City 
State
Zip code 
Name and phone number of emergency contact (in the event you cannot be reached)  *
Name and phone number of emergency contact (in the event you cannot be reached)  *
Please describe any allergies (seasonal, food, insect) and treatment protocol.
*
Please describe any dietary restrictions (we ask that families provide their own meals/snacks as necessary) 
*
Does your child complete toileting independently? (toileting independence is not required)
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Please describe any relevant medical history, diagnosis (es), assistive devices, or supports needed to enhance your child's participation. 
Please describe your child's interest, strengths, or anything else you would like us to know about your child.  
Please list any GENERAL goals for your child while attending camp. (ex. motor skills, sensory, etc.)
“I understand that Peaks and Bounds will maintain my privacy to the highest standards.  I understand that personal information will not be shared with anyone not affiliated with Peak and Bounds  I understand that personal information received through this registration will only be shared with professional staff and volunteer staff at Peaks and Bounds to ensure the safety of my child and to ensure my child receives appropriate support needed while at camp."
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Would you like to be added to the mailing list to be updated on future events?

Your email address will not be used for any purpose other than to provide you with information.  At any time, you can be removed from the mailing list.
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I understand I MUST complete the following waiver(s) prior to my child participating in their first day of camp.  *
I understand that if my child is participating in a service located at Friends with Laughing Buck Farm, I MUST complete the following waiver prior to my child participating in their first day of camp.  *
Cancellation Policy: 
1. Cancellation 3 weeks or more before camp start date will result in a full refund. 

2. Cancellation of a camp 2 weeks prior to the camp start date will result in forfeit of half of the registration fee with refund of the other half.  

3.  Cancellation by the family 1 week before camp start time will result in forfeit of the entire registration fee.  

4. Cancellation by the family part way through a camp due to illness or vacation or other unexpected events, cannot be refunded and families forfeit the registration fee.  

 5.  Cancellation of a camp by Peaks & Bounds, Inc because of low numbers, would result in full refund. 

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Required
I understand my loved ones spot is not reserved until secure registration payment has been received. I can find the link to payment at peaksandbounds.com under > services >  next to the program I am registering my loved one for. *
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