Friends of Dirt Camp
June 12- Aug 9 Enrollment Weekly
9am-1pm
Ages 3 -9
Ages 10 and up can apply to be counselors (johnandmary4958@gmail.com)

Week 1 June 12-16 Full
Week 2 June 19-23 Full
Week 3 June 26-30 Full
Week 4 July 10-14
Week 5 July 17-21 is Full for some days, choose "other" or email Mary
Week 6 July 24-28
Week 7 July 31-August 4

5 days $140/week; 3 days $90/week
2nd child in a family has 10% discount, add an additional 10 % discount for 3rd child
Activity fee of $15/week/family

Email address *
"Nature immersion" :) Dirt Camp is in its 15th year of providing outside summer experiences for children in the High Country. Originally designed for Mary's Montessori school students, we open up a few spots each week to former students, friends and visitors. Every day we have art, games, and outside educational speakers.
Child(ren)'s name *
Your answer
Child(ren)'s Date of Birth *
Your answer
School/group experiences? *
Your answer
Tell us about your child
Your answer
What do you want your child to get from camp?
Your answer
Are you interested in aftercare?
If aftercare is wanted, which weeks/days/times?
Your answer
Weeks wanted: Week 1 June 12-16 is full
Your answer
If "other", what would you like?
Your answer
Week 2 is full
Your answer
If "other", what would you like?
Your answer
Weeks wanted: Week 3 June 26-30 is full
Your answer
If "other", what would you like?
Your answer
Weeks wanted: Week 4 July 10-14
If "other", what would you like?
Your answer
Weeks wanted: Week 5 July 17-21
If "other", what would you like?
Your answer
Weeks wanted: Week 6 July 24-28
If "other", what would you like?
Your answer
Weeks wanted: Week 7 July 31-August 4
If "other", what would you like?
Your answer
Parent/Guardian Name *
Your answer
Email addresses *
Your answer
Address *
Your answer
Town, Zip *
Your answer
Payment type
Primary contact phone number (8 am-2 pm) *
Your answer
Home phone number *
Your answer
cell phone *
Your answer
work phone
Your answer
Additional parent/guardian name
Your answer
secondary contact number
Your answer
cell phone
Your answer
work phone
Your answer
Persons to whom this child can be released or contacted in the event of an emergency *
Your answer
Name/relationship *
Your answer
contact phone number *
Your answer
name/relationship
Your answer
contact phone number
Your answer
name/relationship
Your answer
contact phone number
Your answer
Name of anyone to whom child is NOT to be released
Your answer
Please provide program coordinator with photo and legal documentation (if applicable)
Your answer
Please state the nature of any disability, chronic illness or health condition of your child, any medications being taken, or any other information needed to help assure safe daily care or medical treatment in case of an emergency.
Your answer
Please give any information which may be helpful to your child's experience in a group setting
Your answer
We will email you about availability for your request! Warmly, Mary and Lynn
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