2023 Camp Application Camper's Name(Required) First Last Camper Birthdate(Required)This summer, our camp is designed for kids ages 5.5 through 9. If your camper is not within this age range, his or her application will likely be declined. Thanks for your understanding of our goal to create the best fit for the whole group. Has camper attended Pono Grown summer camp before?(Required) Yes No Are there any changes to camper's health conditions, physical limitations, or allergies since he or she last attended camp? Yes No Please describe any changes to camper's health conditions, physical limitations, or allergies since he or she last attended camp. Does camper have any allergies? Yes No Please list all allergies, and describe camper's reaction to any exposure. Does camper use an epipen? Yes No Does camper have any health concerns or medical conditions? Yes No Please list all health concerns and medical conditions.Also describe any necessary medications or treatments that may affect his or her participation at camp. Does camper have any physical limitations? Yes No Please describe camper's physical limitations. Camper's Gender(Required) Siblings(Required)Does your camper have a brother or sister who is also attending Pono Grown camp this summer? Yes No Sibling's Name(Required) First Last Sibling's Birthdate(Required) Has sibling attended Pono Grown Farm and Nature Camp before?(Required) Yes No Does sibling have any allergies? Yes No Please list all allergies, and describe sibling's reaction to any exposure. Does sibling use an epipen? Yes No Does sibling have any health concerns or medical conditions? Yes No Please list all health concerns and medical conditions.Also describe any necessary medications or treatments that may affect his or her participation at camp. Does sibling have any physical limitations? Yes No Please describe sibling's physical limitations. Are there any changes to sibling's health conditions, physical limitations, or allergies since he or she last attended camp? Yes No Please describe any changes to sibling's health conditions, physical limitations, or allergies since he or she last attended camp. Sibling's Gender(Required) Is there anything else you'd like us to know about your camper(s)?Parent or Guardian's Name(Required) First Last Relationship to Camper(Required) Are there any changes to your contact info or your emergency contact choice since your camper last attended Pono Grown Camp?(Required) Yes No Parent/Guardian's Phone(Required)Parent/Guardian's Email(Required) Preferred Contact Method(Required)We will contact you as little as possible, but want to make sure that when we do it's as easy as can be, so let us know how you prefer to be reached. Text Message Phone Call Email Additional Parent/Guardian's Name First Last Relationship to Camper Additional Parent/Guardian's PhoneAdditional Parent/Guardian's Email EMERGENCY CONTACT Name(Required)Please name SOMEONE OTHER than THE parent(s)/guardian(s) listed above. Parent(s)/Guardian(s) will be contacted first in case of an emergency. This gives us an additional adult to contact in case we cannot reach you for some reason. First Last EMERGENCY CONTACT Phone(Required)EMERGENCY CONTACT'S RELATIONSHIP TO CAMPER(Required) Camper Photo Release(Required)I agree to have photos/videos of my child's camp experience taken and shared in future camp promotional efforts online and/or in print. Yes No I agree to have camper photos taken, but not publically shared Liability Waiver(Required) I give consent for my child/children to participate in Pono Grown camp activities, and execute the liability release described herein on his/her/their behalf. I agree to assume responsibility for all risks, injuries, damages (known or unknown) associated with my child's/children's participation in Pono Grown camp activities. I also agree to inform the camp coordinator of any actions or movements which I feel my child/children cannot safely perform. I will inform the camp coordinator of any limitations, medical conditions, or other special considerations that may affect my child's/children's safety during these camp activities in Makawao, Hawaii. I discharge in advance Pono Grown LLC, Danielle and Evan Ryan, and all officers, employees, contractors, and volunteers from all liability related to my child's/children's participation in and presence at camp. Furthermore, I forever waive any claim I, my heirs, or my legal representatives my have against the above mentioned persons and entities.Healthy Camper Agreement(Required) I agree to only send my child/children to Pono Grown camp in a healthy condition. I agree to keep him/her/them home if they exhibit any symptoms of illness including but not limited to chills, cough, shortness of breath, fatigue, runny nose, watery eyes, congestion, body aches, headache, sore throat, diarrhea, nausea, vomiting, or lice. I understand that I will be contacted to pick up my camper(s) immediately if he/she/they shows signs of illness at camp.Consent for Emergency Medical Treatment(Required) I give consent to have my child/children treated by emergency medical personnel, a physician, or surgeon in the case of sudden illness or injury while participating in Pono Grown Camp activities. I understand that any necessary medical treatments will be my expense.Electronic Signature(Required) I have read the liability waiver, healthy camper agreement, and consent for emergency medical treatment. I fully understand their contents, and agree to all of their terms and conditions. I agree that all the information contained in this application is accurate and will notify camp coordinator immediately with any changes.My name entered here serves as my electronic signature(Required) Date(Required) Pono Grown Camp Options(Required) Eight Weeks $2,080 Seven Weeks $1,960 Six Weeks $,1680 Five Weeks $1,400 Four Weeks $1,200 Three Weeks $900 Two Weeks $600 One Week $320 Camp Week Selection(Required) Week 1: June 6 - 9 , 2023 (FULL - join waitlist) Week 2: June 13-16, 2023 (FULL - join waitlist) Week 3: June 20-23, 2023 (FULL - join waitlist) Week 4: June 27- 30, 2023 (FULL - join waitlist) Week 5: July 4-7, 2023 (FULL - join waitlist) Week 6: July 11-14, 2023 (FULL - join waitlist) Week 7: July 18 - 21, 2023 (FULL - join waitlist) Week 8: July 25-28, 2023 (FULL - join waitlist) Select AllPono Grown Camp Options for Sibling Eight Weeks $2,080 Seven Weeks $1,960 Six Weeks $,1680 Five Weeks $1,400 Four Weeks $1,200 Three Weeks $900 Two Weeks $600 One Week $320 Camp Week Selection for Sibling Week 1: June 6 - 9 , 2023 (FULL - join the waitlist) Week 2: June 13-16, 2023 (FULL - join the waitlist) Week 3: June 20-23, 2023 (FULL - join the waitlist) Week 4: June 27- 30, 2023 (FULL - join the waitlist) Week 5: July 4-7, 2023 (FULL - join the waitlist) Week 6: July 11-14, 2023 (FULL - join the waitlist) Week 7: July 18 - 21, 2023 (FULL - join the waitlist) Week 8: July 25-28, 2023 (FULL - join the waitlist) Select AllSibling Discount Price: $0.00 How did you hear about Pono Grown Camp?(Required) Payment Options(Required)$100 PER WEEK DEPOSIT (per camper) is required to hold your spot(s). Assuming we accept your application, we will hold your child's/children's spot(s) for 7 days after your application is received. If payment or contact to make payment has not been made within 7 days, their spot will no longer be reserved. Once their spot is confirmed, the remainder of your balance will be due by May 1, 2023. The deposit is non-refundable except if the camp week(s) you've selected are canceled by Pono Grown. No deposit is required to join the waitlist if a week you are hoping to join is already full. For payment, I will Venmo Danielle @Danielle-Ryan-55 Drop off cash. Text Danielle at (808) 280-0201 to arrange Mail a check to Danielle Ryan at 677 Olinda Road, Makawao Hi 96768 Join the waitlist (no deposit or payment is required unless a spot opens for your camper) Total
