Family Information and Media Consent Form

This form must be submitted before your child's first day of camp or after school.

Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Child's Address *
Child's Address
Guardian 1 Name *
Guardian 1 Name
Guardian 1 Phone Number *
Guardian 1 Phone Number
Guardian 2 Name
Guardian 2 Name
Guardian 2 Phone Number
Guardian 2 Phone Number
Child's Physician Name *
Child's Physician Name
Child's Physician Phone Number *
Child's Physician Phone Number
Are there any people who should not have any contact with your child? *
What do you hope your child will get out of attending Alamander Camp? Is your child experiencing any transitions (such as a new sibling, recent move or separation)? Please share anything else you think we should know about your child here!
If your child is enrolled in Holiday Break Camps, please choose the day(s) they will be at camp below:
Media Consent *
During Alamander sessions, we post media (photos, video, audio, text) to our website and our Facebook page. Some of the content we post may include images, text, or sound of / produced by your child(ren). We are asking for your written consent as parent / guardian to post such media. Pursuant to law and out of respect for your child(ren) and family, we will never include identifiable information such as your child’s last name, mailing address, any email addresses, or phone numbers. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the camp director and such rescission will take effect upon receipt by the camp.
Walking Field Trip Consent *
Alamander Camp goes daily on neighborhood walking trips to nearby playgrounds, parks, libraries and stores. Consent will be requested on a separate form for all trips that require forms of transportation other than walking.