The Buzz is Out!

Spots are full for our Pollinating Potential Summer Camp program this year!

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Pollinating Potential Summer Camp Application Form

First name

Last name

Phone

Address

Relationship to Camper

Parent

Guardian

Emergency Contact Name (First & Last):

Emergency Contact Phone Number

Does the camper receive free or reduced lunch? Is the youth a recipient of SNAP/WIC benefits?

Camper's Full Name

Camper's Date of Birth

Does the camper have any allergies or dietary restrictions? If so, please list them

We capture media of campers during camp activities. This media may be used for promotional purposes on our website and social media platforms as well as our partners and sponsors. Within enrolling your youth, you provide consent for media release.

Yes

Camp transportation is provided at your own risk. We waive all liability for any accidents or injuries that may occur during transportation. Do you agree to this waiver of liability for transportation for BEEnevolent and our program partners?

Yes

Camp participation involves inherent risks. We waive all liability for any injuries or illnesses sustained by your child during camp activities, on-site, or during transportation offered by us or our partners. Do you agree to this waiver of liability?

Yes

Signature

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Pollinating Potential Summer Camp Application Form