Each child is unique and special. As a parent, you know that—and we want to assure you that the Children’s Program at Northern Pines understands that too! Our programming throughout the week is thoughtfully designed around the Northern Pines mission of being a “Vacation with a Purpose.” The Children’s Program aims to be Christ centered, while being fun and flexible—and having a variety of children’s needs and interests in mind! Please fill out this form for each child you have registered in the Children’s Program (ages birth to entering third grade). Please only submit one form per child. Please visit the Parent Portal for additional forms. Section One: Child's InformationChild's NamePlease list the name used when you registered this child. First Last Child's Nickname or Prefered NameThis will be the name used for class lists and name tags.Child's Birthdate Month Day Year Child's gender: Boy Girl Will this year be this child's first time at Northern Pines? Yes No Which week is this child attending?(Required) Week 1: July 20–July 26, 2025 Week 2: July 27–August 2, 2025 Unaccompanied Minors(Required)Will this child attend Northern Pines with one of their parents or legal guardians? Yes. This child is attending WITH a parent or legal guardian NO. This child is attending WITHOUT a parent or legal guardian Section Two: Parent or Guardian InformationPlease provide information on who we should contact during camp if necessary. If the child is attending without his/her legal guardian, please also submit the Unaccompanied Minor Form available on the Parent Portal.Parent or Guardian #1Name (Parent/Guardian #1) First Last Relationship to Child (P1)Cell Phone Number (P1)Is this adult also attending Northern Pines this summer? (P1) Yes Yes, on Staff No Parent or Guardian #2Name (Parent/Guardian #2) First Last Relationship to Child (P2)Cell Phone Number (P2)Is this adult also attending Northern Pines this summer? (P2) Yes Yes, on Staff No Section Three: Morning ProgramThe following section is to help prepare our morning program staff. Note: The information you share on this form will be held in confidence. It will be made available to the Children’s Program Directors, (Lee & Leah Nelson) and only with the other Northern Pines staff they deem appropriate—who will also regard the information as confidential. What should we know about this child regarding any pertinent health considerations? (e.g. medications, food allergies, dietary concerns, seasonal or other outdoor allergies, accommodations that we should be mindful of for physical activities, etc.)What should we know about this child regarding any social / emotional considerations? (e.g. sensitivities to certain stimuli, separation anxiety factors, comfort items, calming strategies, etc.)If your child uses tools (i.e. noise-canceling headphones, etc.) to assist with sensory issues, please bring them to campIs there anything else you think would be helpful to know about this child? (e.g. behavioral, academic, and / or any other special needs / accommodations)Section Four: Evening Childcare (CCAs)The following section is to help prepare our CCA Program staff. The CCA Program Directors will use the information you provide to pair your family with a CCA. Some families may share CCAs or be paired with two CCAs; please answer the following questions specifically for this child.CCA for infants This child is an infant, please provide a CCA This child is an infant, I would like to keep my him/her with me and will not need a CCA This child is not an infant/Not Applicable Some parents of infants choose not to leave their infant with a CCA; opting instead to keep their baby with them during the evening programing. Please select whether or not you'd like a CCA for your infant. This choice will not impact your older children's CCA assignment.)Does this child wear diapers? No Yes Yes, but in the process of toilet training Do you anticipate being out after 11pmFree childcare is provided until 11pm. Your CCA can stay an additional hour for $10/half hour. Please return to your children by midnight. Unlikely Likely one or two evenings Likely every evening Unsure/TBD Specific CCA RequestIs there a specific CCA you'd like to request to have this year? Several factors go into pairing CCAs with families, so we cannot guarantee you will be paired with your requested CCA, but we will try.Is there anything should we know about your child regarding any pertinent health considerations or behavioral issues which could impact evening activities or care?Is there anything else you would like us to consider when pairing a CCA with your child?The following information will be shared with your assigned CCA.Bed Time InstructionsAdditional Instructions/CommentsThank you for filling out this form! When you hit the "Submit" button, you will be redirected back to the Parent Portal.
