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). Provide this information about your child by July 1, so that we can prepare for a great week with your child(ren) at Northern Pines! 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. Please only submit one form per child. If a child is attending without a legal guardian, please also fill out the Unaccompanied Minor Health Form. For children fourth grade and older, please fill out the Youth Health Release Form. The Children's Program Information Form is specifically for the Children's morning program.Which week the child is attending?(Required) Week 1: July 21–July 27, 2024 Week 2: July 28–August 3, 2024 Is this your first time at Northern Pines with children in the Children's Program? Yes No Name of Child First Last Child's gender: Boy Girl Nickname (if different than name on registration): Birthdate MM slash DD slash YYYY Age of child while at camp: (If applicable) Grade ENTERING in Fall 2024: Please list the grade your child will be entering this upcoming fall. This form is for children going into third grade or younger.CCA for infants Please provide a CCA for my infant I would like to keep my infant with me and will not need a CCA for him/her 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.)Name of Parent / Guardian #1: First Last If this child is attending without his/her legal guardian, please list contact info for his/her at-camp guardian.Parent #1 Cell number:Name of Parent / Guardian #2: First Last Parent #2 Cell number:What should we know about your 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 your 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 your child? (e.g. behavioral, academic, and / or any other special needs / accommodations)
