2. Name of Camp*
   -- Select One --Pirates & Scallywags (8/13) ~ FULL waiting list onlyThe Exhilaration of Otters (8/14) ~ FULL waiting list onlyWhat Floats Your Boat (8/15)Catch of the Day (8/16)Junior Paleontologist for a Day (8/17)
3. Entering Grade*
   -- Select One --123456789
5. Child's Name*
6. Date of Birth*
   Date of Birth
7. Age*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Parent/Guardian Name*
18. Home Phone
20. Work Phone
21. Cell Phone
23. Parent/Guardian Email*
    Email will be used to send confirmation of registration.
25. Are you a current museum member?*

    1. Yes

    1. No
26. *Cancellation must be received 10 business days before camp for refund, minus $5 processing fee.
30. Emergency Contact Information
32. Name 1*
33. Relation*
35. Home Phone
36. Work Phone
37. Cell Phone
39. Name 2
40. Relation
42. Home Phone
43. Work Phone
44. Cell Phone
48. Medical Information
50. Date of last tetanus immunization*
51. Primary Physician*
52. Physician Phone Number*
54. Allergies
    Pertinent information on any significant medical conditions or allergies
56. Is child enrolled in a Maryland school?

    1. Yes

    1. No
57. If "yes" what is the name of the school?
59. Is camper missing any immunization because of medical contraindication or exemption by religious belief?

    1. Yes

    1. No
61. Non-Maryland Students
    If camper is not registered in a Maryland school, you must furnish the Calvert Marine Museum required records of immunization, contraindication statement from child's physician or exemption by religious belief statement before child can be admitted to the program.
65. Waiver Release
    I hereby give permission for my child to participate in all activities and attend all trips sponsored by the Calvert Marine Museum under the auspices of the Calvert County Division of Parks and Recreation. In consideration of the division's accepting my child into this program, I agree to waive and forever discharge Calvert County, its employees and agents harmless of & from any injuries sustained by my child which occurs while enroute to or from or participating in any activity sponsored by the aforementioned parties. I also grant my permission to use any photographs of my child taken during camp for promotional purposes. NOTE: This release does not obligate your child to attend any or all scheduled trips or activities.
66. Waiver Release Agreement*

    By checking the box marked "I Agree" you are agreeing to the Waiver Release.

    1. I Agree
70. Sign Out Release
    Upon dropping off and picking up my child from the camp, I agree to inform the director and sign the appropriate form, including date and time I dropped off and picked up my child. In the event I am unable to pick up my child, I agree to call the school/center and inform the director with the name of the individual I authorize to pick up my child. I agree to provide the Calvert Marine Museum with the names of individuals I authorize to pick up my child when I am unable to do so myself. (See names listed below.) I realize it is my responsibility to keep this list updated and accurate.
71. Sign Out Release Agreement*

    By checking the box marked "I Agree" you are agreeing to the Sign Out Release.

    1. I Agree
75. Child's Walk/Ride Bike/Sign-Out Permission Release
    I give my child permission to walk and/or ride his/her bike to and from the camp site and permission to sign him/her self in and out of camp each day. NOTE: Calvert Marine Museum and Calvert County Parks and Recreation cannot be held accountable once your child has been signed out!
76. Sign-Out Release Agreement

    By checking the box marked "I Agree" you are agreeing to the Sign-Out Permission Release.

    1. I AGREE
    2. I DO NOT Agree
80. Authorized Persons for Pick-Up
    Remember: You are responsible for ensuring the list is updated and accurate.
82. Name 1*
83. Phone Number 1*
85. Name 2*
86. Phone Number 2*
88. Name 3
89. Phone Number 3
91. Name 4
92. Phone Number 4
96. UN-Authorized Persons for Pick-Up
    Remember: You are responsible for ensuring the list is updated and accurate.
97. 1. Does Not Apply to my child
99. Name 1
100. Phone Number 1
102. Name 2
103. Phone Number 2
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit

* indicates a required field