Urban Dunes Sand Explorers Day Camp

Parent/Guardian Information

Parent First name*

Parent Last name*

Email*

Phone*

Child Information

Child's Full Name*

Child's Date of Birth*

Month

Day

Year

My Child is Fully Potty Trained.

Camp Dates Selection

Please select the days that your child will be attending camp.

February 17

February 18

February 19

Emergency Contact

Full Name of Emergency Contact Person*

Relationship*

Phone

Authorized Pick-Up (Photo ID Required)

Full Name*

Phone

Full Name

Phone

Same as Parent/Guardian

Allergies & Medical Information

My Child Has No Allergies

My Child Has Allergies

List Allergies

I understand that Urban Dunes is not a nut-free facility.

Bathroom Assistance

I authorize Urban Dunes' staff to provide my child bathroom reminders and verbal assistance.

Program Acknowledgment

The Day Camp is a Drop-off Only Program.

Pick Up Time is 2:30 p.m. (late pick-up may incur fees).

Unsafe behavior may result in early dismissal.

Message

This Acknowledgment and Consent is an addendum to the existing Urban Dunes Waiver.

By registering my child for the Urban Dunes Day Camp, I acknowledge and agree to the following:

My child is between three (3) and seven (7) years of age and is fully potty trained.
This is a drop-off program, and I agree to arrive on time for pick-up in accordance with the schedule published by Urban Dunes.
I understand and agree that my child will participate in sand-based activities, which may include sand play, arts and crafts, and story time.
I have fully disclosed all known allergies, medical conditions, and special needs relating to my child.
I understand and acknowledge that Urban Dunes is not a nut-free facility.
I consent to my child being supervised in group settings of varying sizes, as determined by Urban Dunes staff.
I understand that disruptive, unsafe, or inappropriate behavior by my child may result in early dismissal from the program without refund.