KIDS INTAKE FORM

EARTHKIN GATHERING KIDS CAMP

CHILD INFO

First Name

Last Name

Date of birth

yyyy-mm-dd

Pronouns

What does your child like to be called (e.g. he, she, they)?

PARENT/GUARDIAN CONTACT 1

First Name

Last Name

Relationship with child

Email

Phone

(###)

###

####

PARENT/GUARDIAN CONTACT 2

First Name

Last Name

Relationship with child

Email

Phone

(###)

###

####

Persons who have permission to pick up your child

Health Details

Please describe any medical concerns, allergies/sensitivities, behaviour, medications, speech or language, vision/hearing impairments, fears, comforts etc.

What are your child's passions?

What are your child's challenges and growth areas? How can we support them when they are struggling?

What is your child's experience in nature?

Is there anything else you would like us to know?

Please fill out one intake form for each child you would like to enroll in kids camp.