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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.
Email(Required)
Please provide an email address so we can send you a copy of your submission.

Section One: Child's Information

Child's Name(Required)
Please list the name used when you registered this child.
This will be the name used for class lists and name tags.
Child's Birthdate(Required)
Child's gender:(Required)
Will this year be this child's first time at Northern Pines?(Required)
Which week is this child attending?(Required)
Unaccompanied Minors(Required)
Will this child attend Northern Pines with one of their parents or legal guardians?

Section Two: Parent or Guardian Information

Please 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.

If this information is the same as a previous submitted form please provide that child’s name and then you can skip this section.
Parent or Guardian #1
Name (Parent/Guardian #1)
Is this adult also attending Northern Pines this summer? (P1)
Parent or Guardian #2
Name (Parent/Guardian #2)
Is this adult also attending Northern Pines this summer? (P2)
Alternate adult contact for someone who will be at Northern Pines with this child if both parents/guardians are not attending.
Name (Alternate Adult)
Is this adult also attending Northern Pines this summer? (AA)

Section Three: Morning Program

The 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 camp
Is 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(Required)
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?(Required)
Do you anticipate being out after 11pm(Required)
Free childcare is provided until 11pm. Your CCA can stay an additional hour for $10/half hour. Please return to your children by midnight.
Is 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? (Please include even if it's a repeat from the morning section; this information goes to different teams).
Is there anything else you would like us to consider when pairing a CCA with your child? Please note: Male CCAs will not be assigned to families unless there is a grade-school boy and/or if they are paired with a female CCA.
The following information will be shared with your assigned CCA.
Is there anything you'd like to share for your evening child care for your family as a whole? You can enter it with the first child's form and skip this question for the remaining children in your household.