Clear Kids Camp - Application
Please submit One form for EACH CHILD wishing to attend.

Day Camp: Monday & Wednesday (possible Friday field trips also)
June 8-July 1st, 2020
Address: 79 W 700 S Ivins, Utah 84738

Deposit: $50 to hold your space
Tuition: Conscious Giving (see below for more info or financial aid)

Contact us at (801)917-4488 or
See webpage for more details about the camp

Information for Parents/Guardians:
What is Clear Kids Camp? It’s a coeducational day camp, which utilizes two secular, evidence-based programs: 1- MindUP (founded by the Goldie Hawn Foundation) – a Social Emotional Learning program that helps kids learn to focus their attention, improve their self-regulation skills, build resilience to stress, and develop a positive mind-set; 2- Self-Inquiry -a process that supports all ages in exploring different perspectives of our STORIES and creating space to CLEAR our emotional waves! PLUS of course, we include lots of fun and creative activities too! More info on website.

Applicants should be prepared to meet expectations for physical activity, positive social interaction in a group setting, and cooperative participation in shared duties and responsibilities typical of a summer day camp environment. Those seeking a solely recreational experience will likely not be happy.

Clear Kids Camp does not discriminate on the basis of race, sex, gender identity or expression, or religious affiliation and encourages applicants from persons of any ethnicity, race, or background.

Qualified applicants will be accepted on a first-come, first-serve basis, and therefore we encourage a timely submission of this application. After a session fills, additional applicants will be notified and given the option of being placed on a waiting list.

All campers are expected to be in good mental, emotional, and social health and be able to participate fully in lessons, prepare written and craft projects, and participate in indoor and outdoor activities.

>>>Please be aware that we have pets at our property, and camper's may come in contact with animals or their dander/hair.<<<

In response to the current virus concerns, we will be taking extra precautions in cleaning all common areas, encouraging thorough hand washing, asking anyone with viral symptoms to stay home and limit our participant numbers to 10 campers per group.

We're excited for the opportunity to serve your family and HAVE FUN!

All submissions on this form are PRIVATE & CONFIDENTIAL
Email address *
Parent or Guardian's Name *
Relationship to child *
Parent or Guardian's Phone Number *
Home Address *
Camper's Full Name (child) *
Camper's Birth Date *
Camper's Gender *
Session Time *
Health & Medical Information *
Please briefly list an Allergies, Injuries, Mental, Emotional Health, or any other issues. (Please be aware, we have pets at our location, so camper's with animal allergies may need to consider the possibility of encountering pet dander)
Does the camper require special accommodations to participate in Clear Kids Camp? *
Dietary restrictions or allergies *
Application Deposit:
Clear Kids Camp cannot hold spaces without an application and deposit for a specific camper. A $50 deposit with camper’s full name must accompany each application; the deposit is not refundable if camper is accepted. Payments accepted via Venmo or PayPal.

We recognize, however, that some families may be unable to afford the full cost of the deposit. Clear Kids Camp is able to provide some financial assistance to promising new and outstanding returning campers. While we cannot guarantee reduction for every applicant, no one should be discouraged from applying simply because of prohibitive cost. Assistance will be awarded, however, only as funds are available. For more information or to apply for financial aid from Clear Kids Camp, please e-mail to obtain a request form.
Form of payment:
We request that deposits are made immediately following submission of the this application submission.
Clear selection
Tuition: Conscious Giving
You may be asking "What the heck is Conscious Giving?"

To us it's simply this... Give what resonates for YOU! In other words, your contribution is self-determined!
(More info ---> )

As we mentioned above, we do ask for an initial $50 deposit to hold your space in the program, to cover material/snack costs. At anytime, you are welcome to contribute more. Please consider that other summer day camp prices vary considerably - such as $100 to $1000 per session. That being said, ANY amount you can give is generously appreciated and welcomed!

Of course, the more you are able to give, the more chance for other camper's who may not be able to contribute. Please indicate any such donation accordingly if included with a deposit. Thank YOU!
Are you potentially available to provide rideshare transportation to and from Clear Kids Camp for other campers? Some families face difficulty driving to Clear Kids Camp at the beginning or end of a session. If you would be willing to be contacted by camper families in your area who may need transportation, please check the box below. Doing so carries no obligation to provide such a service.
Clear selection
Parent/Guardian Release: *
If Clear Kids Camp finds at any time that it is not able to reasonably accommodate a camper, we will inform the parent/guardian as soon as practicable and immediately refund any deposit or funds contributed. Any false information or omissions may result in your camper’s exclusion from Clear Kids Camp, without obligation for refund. Please check each box below in compliance of this form.
Electronic Signature of the above listed minor *
I, by virtue of my electronic signature below, signify that to the best of my knowledge, the information provided in this form is true and correct. Please type your full name in the space below.
A copy of your responses will be emailed to the address you provided.
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