2025 Spring Break Mini-Camp Wellbeing Packet

Parents: please complete this form after registering your child for Spring Break Mini-Camp and least 10 days prior to the first day of camp. We may contact you for additional information. This form takes about 15 minutes to complete.

Step 1 of 4

Camper Information

Camper Name(Required)

First Last

Camper Pronouns

Camper Name for Name Tag

Camper Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Camper age(Required)

Current Grade(Required)

Registered Camps

Camps for your child that you have already registered and paid for. Select all that apply.

4/14-4/16 Spring Break Mini-Camp: Full 3 Days

4/14 Spring Break Mini-Camp: Treasure Hunt

4/15 Spring Break Mini-Camp: Hooked on Fishing

4/16 Spring Break Mini-Camp: Outdoor Survivor

Parent/Guardian Name(Required)

First Last

Parent/Guardian Phone Number(Required)

Parent/Guardian Email(Required)

Emergency Contacts

Fill in emergency contact information – can be a parent/guardian, relative, family friend, etc. You may include the same parent that you previously listed above in the emergency contact list if applicable.

Emergency Contact #1 – Name(Required)

First Last

Emergency Contact #1 – Relationship to Child(Required)

Emergency Contact #1 – Phone Number(Required)

Emergency Contact #2 – Name(Required)

First Last

Emergency Contact #2 – Relationship to Child(Required)

Emergency Contact #2 – Phone Number(Required)

Emergency Contact #3 – Name

First Last

Emergency Contact #3 – Relationship to Child(Required)

Emergency Contact #3 – Phone Number(Required)

Camper Contract

At Venture Outdoors, we strive to create meaningful and healthful experiences for children in the outdoors. In order to do so, we foster an environment where safety and wellbeing are of utmost importance. Please review and discuss the following guidelines with your child prior to the program. We will review this contract during the program and have students sign their understanding and agreement.

Driving Youth

Acknowledgement & Assumption of Risk Form

Phone

Signature

	Yes	No
Asthma or other respiratory problems
Gastrointestinal disturbances
Diabetes
High blood pressure
Bleeding or blood abnormalities
Neurological problems or epilepsy
Dizziness or fainting episodes
Migraines
Heart problems
Disorders of urinary or reproductive tract
Knee, hip or ankle injuries and/or surgeries
Shoulder, arm, or back injuries and/or surgeries
Head injury
Child greatly affected by heat
Child gets cold easily
Stroke

	Yes	No
Any other allergies, such as food, medication or seasonal?
Will child carry an inhaler or epi-pen?
Does child have special dietary needs, such as vegan/vegetarian?
Does child have muscle spasms?
Is child taking medication?
Will child require medication during our program hours?

	Yes	No
Does your child have a mobility impairment?
Is your child sensitive to sights, sounds or other sensations?
Has your child ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?
Has your child ever been treated for emotional or behavioral difficulties or an eating disorder?
Has your child experienced a significant life event that continues to affect the child’s life?
Is your child uncomfortable with water?
Is English a 2nd language for your child? If yes, please indicate primary language in box below.

2025 Spring Break Mini-Camp Wellbeing Packet