Camp Registration

CHILD REGISTRATION FORM 2017

You must complete registration returning to the website and by paying via PayPal, or by sending checks to: Dacia Dauner 7596 Miltona Dr SW Bemidji, MN 56601

5% discount if you register by June 1, 2017. Take another 5% off when you sign up 2 or more siblings. Please fill out separate forms for each child.

Email address
Please select the camp(s) you are registering from the list below. You can register for multiple camps with one application.
My child needs Early Arrival at 8:15. Please select the days needed from the list below. Cost is $5 for 2 days, $8 for all 4.
Child's Name
Your answer
Child's DOB: 4 year olds must be 4 by February of 2017 and able to participate without a nap until 2:00 pm. 3 year olds for Maggie B. Camp must be 3 by February 2017 and fully potty trained.
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Name to which child responds
Your answer
Parent/Guardian name(s)
Your answer
Address, city, state and zip
Your answer
Parent/guardian primary phone
Your answer
Parent/guardian secondary phone
Your answer
Parent/guardian email
Your answer
Name of child's primary physician
Your answer
Physician's phone
Your answer
Name of child's dentist
Your answer
Dentist's phone
Your answer
Name, Address and Phone of persons authorized to pick up your child:
Your answer
Name, Address and Phone of persons to be notified in case of emergency, when parent or guardian is not available:
Your answer
Illnesses, accidents, allergies, and surgery child has had (please include childhood diseases and specify allergies):
Your answer
Has your child had previous group experiences such as school, preschool, camps, childcare?
Does your child have any special needs?
If yes, please describe.
Your answer
I give my permission for my child to participate in all planned activities at camp, including messy outdoor play.
I will be responsible for providing appropriate clothing.
I give my permission to have my child's photo taken for the Apple Blossom website.
By adding my name below, I give my consent for emergency medical treatment or care, to be used only if I cannot be reached immediately.
Your answer
By adding my name and the date below, I agree to enroll my child in the Apple Blossom Camps I have checked above. I understand that I am responsible to pay for the full amount of camp even if I choose to leave early or if my child’s needs are too great to be met by this camp and my child is dismissed from camp by the educators. Children must be able to follow educator directions and be safe and kind. I have read the Apple Blossom Summer Camp handbook. Except in cases of sole custody, both parents’ signatures are required for admission.
Your answer
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