Culinary Program Summer Camp Registration

Camper Information

Name*

First Middle Last

Gender*

Male

Female

Date of Birth*

Month

Day

Year

Age*

Family Information

Guardian 1*

First Last

Relationship to Camper*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

This is my:*

Cell Phone

Work Phone

Home Phone

Secondary Phone

This is my:

Cell Phone

Work Phone

Home Phone

Guardian 2

First Last

Relationship to Camper

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone

This is my:

Cell Phone

Work Phone

Home Phone

Secondary Phone

This is my:

Cell Phone

Work Phone

Home Phone

PRIMARY Contact Name and Number for this camper.*

Guardian 1

Guardian 2

Parental Agreement

Parent/Guardian is to read each statement and check "I agree". Without this, the application will not be processed.

In case of an emergency, The Culinary Program of End Hunger staff may authorize the physician of choice to provide emergency care if parent/guardian cannot be contacted immediately.*

I agree.

I do not agree.

I do hereby release and hold harmless The Culinary Program of End Hunger and it’s duly appointed employees from all claims and damages due to personal injury to the camper.*

I agree.

I do not agree.

The Culinary Program of End Hunger will notify me should my child become ill or uncontrollable and I will be responsible for picking up my child immediately upon notification.*

I agree.

I do not agree.

I understand my child may not be accepted or may be released at any time from The Culinary Program of End Hunger programs, if it is determined the camper lessened the health, safety, welfare, or enjoyment of him/herself or other participants.*

I agree.

I do not agree.

The Culinary Program of End Hunger has permission to take photographs of my child while in attendance of camp. I also give permission for images to be used for public promotion of the program.*

I agree.

I do not agree.

I realize that I am responsible for picking my child up or having an authorized person to pick up my child on time, each day.*

I agree.

I do not agree.

I understand that the full camp payment must be paid before my camper may attend camp.*

I agree.

I do not agree.

If I have any questions, I understand that I can reach The Culinary Program staff either by phone 410-257-5672 or culinary@endhungercalvert.org.*

I agree.

I do not agree.

Care Information

Please list any specific things we should know about caring for your teen while they are with us at camp.*

Does the camper have allergies?*

Yes

If your camper has any allergies, please list them below as well as a thorough action plan should your student be exposed to the allergen.

Authorized Parent/Guardian Consent

I, the parent/guardian, acknowledge that this information was filled out by me and accurate to the best of my knowledge.

Check box for authorization.

This field is for validation purposes and should be left unchanged.

End Hunger In Calvert County is now doing business as Community Harvest Network. While our name is evolving, our core mission remains the same: Feeding People and Their Futures.

Culinary Camp Registration

Camper Information

Family Information

Parental Agreement

Care Information