2024 Promise Garden Camp Registration Form

español: https://forms.gle/6RED1miQWfabK25o8

Kreyòl ayisyen: https://forms.gle/o2TYQiU4dWdrLQS1A

Garden camp will provide your child with a fun and educational summer program. Children will learn about local plants and animals, complete garden projects, play fun games, and complete a STEM project!

Where: Promise Visioning Garden, 1217 Linden Ave Springfield, Ohio

Grades: Incoming 3rd - 5th graders

Dates: Monday June 17th - Friday June 21st

Time: 8:30am - 12:30 pm

For more information or questions, please contact Ashley Moore at (937) 624-7345 or Abby Gerstenzang (937) 504-2966 or the Promise office at (937) 505-0330

Email *
Child's Name *
Child's Grade (2024/2025) *
Child's Age *
Child's School *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Alternate Emergency Contact Name *
Alternate Emergency Contact Number *
Home Address *
Zip Code *
Any allergies, medical conditions, or dietary restrictions for the registered child *
List all people authorized to pick up the registered child from camp. *
My child is allowed to walk home from Garden Camp *
By typing my full name, I give Springfield Promise Neighborhood permission to care for my child, make appropriate choices to keep them safe, and to photograph and/or videotape my child for promotional purposes only. I understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this form.  In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment for my child as deemed necessary. I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed.  Coverage by Springfield Promise Neighborhood through its accident policy will be used as a backup for what my family's insurance does not cover. I understand all reasonable safety precautions will be taken at all times by Springfield Promise Neighborhood and its agents.  I understand the possibility of unforeseen hazards and the inherent possibility of risk.  I agree not to hold Springfield Promise Neighborhood, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
A copy of your responses will be emailed to .
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