Camp Monroe Registration Form

Camp Monroe: The Lassen Experience is a 6th & 7th grade Standards-Based Study Field Trip. Includes 3 days and 2 nights, private charter bus transportation, cabin accommodations, and “all you can eat” meals.

Each student will need a “bagged lunch” and a snack for the first day.
Due to the fixed costs, trips are planned by bus seat quantity and open to first come, first serve only.
50% deposit check or full-payment shall be submitted with the completed Registration Form to reserve your child’s spot.

Space requirements: 1 bus = 30 students minimum, 40 students maximum per bus. (Camp Monroe can accommodate a maximum of 90 students.)
Students may choose groups 2 weeks prior to departure. Group Sign-Ups will be posted on the locker wall outside Mr. Monroe’s classroom B-7.

Student Information

Name of Student(Required)

First Last

Nickname of Student

Student's email(Required)

Date of Birth(Required)

Gender(Required)

she, her, hers

he, him, his

alternative pronoun

If alternative pronoun, please include:(Required)

School(Required)

Current Grade(Required)

6th

7th

8th

Medical Provider Name(Required)

Medical Provider Number(Required)

(NOT Doctor's Office or Hospital Phone Number)

Does your child have any Special Needs?(Required)

Yes

Please explain any Special Needs:(Required)

Does your child have any particular Dietary Requirements?(Required)

Yes

Please explain any Dietary Requirements:(Required)

Does your child have any Medical or Health Concerns?(Required)

Yes

Please explain any Medical or Health Concerns:(Required)

Is there any additional information that you think we must know about your child?(Required)

Yes

Please explain any additional information that you think we must know about your child:(Required)

The Staff of Camp Monroe will be administering the following over the counter medicines as deemed necessary.(Required)

Select any of the medications below that you DO NOT want your child to be given.

Tylenol (Acetaminophen)

Advil (Ibuprofen)

Calamine Lotion

Pepto-Bismol

Milk of Magnesia

Allergy Tablets (Diphendydramine hydrochloride 25mg Antihistamine)

Dimenhydrinate for motion sickness (marketed as Dramamine, Gravol, and other brand names)

All of the above OTC medications are ok to administer.

Will your child take any prescribed medication(s) or over the counter medication(s) during the hours of the Camp program?(Required)

Yes

Parental Information

Name of Parent / Legal Guardian(Required)

First Last

Name of Parent / Legal Guardian

First Last

Address

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

Phone (Mobile)(Required)

Phone (Night)(Required)

Phone (Day)(Required)

Parent / Legal Guardian's Primary email(Required)

Emergency Contact Information

Name(Required)

First Last

Relationship(Required)

Phone (Mobile)(Required)

Phone (Day)(Required)

Phone (Night)(Required)

Trip Contingency: Camp Monroe reserves the right to cancel camps that do not meet minimum enrollment. If trips do not meet minimum occupancy requirements, a full refund will be issued prior to the scheduled trip. MSES may have partial scholarships available for those students/families experiencing economic difficulties.

Cancellation Policy: Our trips are carefully planned and we must cover fixed operational costs. If you wish to cancel your child’s participation in a trip, your cancellation notice must be received in writing (email) no less than 30 days prior to trip. A $40 fee will apply and be subtracted from any refund. Cancellations with less than 30 days notice of the scheduled trip incur a $75 charge to be subtracted from the refund. Cancellation within 7 days or less will not receive any refund. To receive any refund upon a cancellation within 7 days or less, the situation must be a verifiable special circumstance or emergency. Please Contact Us ↗ to discuss.

Please acknowledgement your acceptance by checking each box below:(Required)

I have read and agree to the Camp Monroe: The Lassen Experience Cancellation Policy.

I grant permission for my child/ward to participate at Camp Monroe: The Lassen Experience. I acknowledge that this is a 3 day / 2 night cabin camping excursion which requires a number of activities with 2-3 hour hikes.

Authorization to treat minor: In the event that I cannot be reached in an emergency, I hereby give my permission to call 911 and/or contact a medical facility or physician selected by the staff to secure proper treatment for my child and that I will be responsible for said expense.

Prescription or over-the-counter medication: I certify that I will have on file with Monroe Science Educational Services, a current medical form stating all the medications that my child must take.

I understand that my child will be responsible and in good conduct to the bus drivers, staff, chaperones, and if applicable adult sponsors at all times. I understand that ALL STAFF are highly-qualified and certified public educators and ALL CHAPERONES MUST BE 21 YEARS OF AGE OR OLDER with a completed Background Check and a current tuberculosis test on file.

There is a Camp Monroe Blanket Insurance Policy that is provided by Monroe Science Educational Services and Sierra Pacific Bus Corporation; however Individual Student Field Trip Medical Insurance is not provided.

In consideration of my child/ward's participation in the activity, I hereby waive all claims or causes of action against Monroe Science Educational Services, Camp Monroe and its auxiliary organizations, and their directors, staff, employees, and agents, arising out of my child/ward's participation in the activity. I also hereby release, hold harmless, and discharge Monroe Science Educational Services from all liability in connection therewith. In addition, I have been advised to obtain personal medical coverage and I agree to use my child/ward's personal medical insurance as a primary medical coverage payment if accident or injury occurs. I also give permission for photographs and/or video to be taken of him/her while participating in this event, and for these photographs and/or videos to be used for publicity purposes.

Date(Required)

Parent / Legal Guardian Signature(Required)

Payment Information

After submitting this form, you will be directed to the payment page.

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Camp Monroe: The Lassen Experience is a 6th & 7th grade Standards-Based Study Field Trip. Includes 3 days and 2 nights, private charter bus transportation, cabin accommodations, and “all you can eat” meals.

Student Information

Parental Information

Emergency Contact Information

Payment Information

Monroe Science Educational Services

Payments Accepted

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