Natural Resources Club 2007 Day Camp Application

---

Please complete all information.
Applications should be sent to: Tawes Garden, E-3, 580 Taylor Avenue, Annapolis, MD 21401
Registration, consisting of complete application and check will be accepted by U.S. MAIL ONLY WITH POSTMARKS NO EARLIER THAN APRIL 20, 2007. No walk-in registrations will be accepted. Make checks payable to: DNR - Tawes Garden

Child's name: _____________________________ Age: _____ Male or Female: __________

Address: ____________________________________________________________________

City, State, Zip:_______________________________________________________________

Telephone (H): _________________________ Telephone (W): _______________________

IN CASE OF EMERGENCY NOTIFY:

Name: _____________________________________________________________

Address: __________________________________________________________

City, State, Zip:_____________________________________________________

Telephone (H): ______________________ Telephone (W): _______________

Please check box of desired session. Please indicate 1st, 2nd and 3rd choices. Children are limited to one session per summer. Camp hours are 9:30 a.m.-4:00 p.m.

Date	Age/Service Charge	CHOICE
June 25-June 29	Ages 6-9 ($140/child)	_________________
July 9-July 13	Ages 6-9 ($140/child)	_________________
July 23-July 27	Ages 6-9 ($140/child)	_________________
July 30-August 3	Ages 6-9 ($140/child)	_________________

Date	Age/Service Charge	CHOICE
July 16-July 20	Ages 10-12 ($160/child)	_________________

Tawes Garden embroidered T-shirts are available by ordering now. Cost is $10 and payment is due with registration. Shirts will be handed out the first day of camp.

Youth Small (6-8) _________

Youth Medium (10-12) _________

Youth Large (14-16) _________

Adult Small _________

Adult Medium _________

Adult Large _________

---

Health History Information

Does your child have any special dietary modifications? __________________________________

Do you carry medical insurance? ________ If so, indicate carrier ___________

Policy/Group # _____________________________

Please list any allergies, diseases or other medical problems you feel we should be aware of:

___________________________________________________________________________________________________________

Photo release:

I hereby give my permission for my child's picture to be used in the Department of Natural Resources publications.
____ Yes ____ No _______________________________________ Parent/guardian signature

Instructions for pick-up: All campers are released at the end of the camp day to their parent/guardian or to one of the people listed on this form.
My child may be released to the following people: Please list Name and Phone #

1. _____________________________________________________________________________

2. _____________________________________________________________________________

RELEASE STATEMENT:
I acknowledge there are natural hazards associated with camp and outdoor activities. I hereby affirm that my child is in good health and physically capable of performing the required activities of camp. In considereation of the Maryland Department of Natural Resources accepting my child and to the extent permitted and provided by State law, I hereby release and forever discharge the State of Maryland, its units, agents and employees from all claims of liability for any damages or injuries which may be sustained while my child is at camp.

_________________________________________________________________________________
Parent/Guardian/Date

Payment

_______ Camp Service Charge
_______ T-shirt

_______ TOTAL PAYMENT ENCLOSED (Please make check payable to DNR-Tawes Garden)

---