Form : Great Lakes Aquarium

Camp Goals & Participation Requirements*

Great Lakes Aquarium camps aim to:
- Ensure the safety and well-being of all campers
- Offer the opportunity for each camper to feel successful
- Offer the opportunity to experience social development, authentic learning and leadership skills

In order to participate in this camp, campers must be able to:
- Take care of their own personal needs (snacks, bathroom, etc.)
- Interact safely and respectfully with fellow campers and Aquarium guests
- Work independently, cooperate safely with peers and follow verbal directions, especially with regard to using SCUBA equipment like buoyancy control devices, regulators, weights, air pressure gauges, etc.
- Identify and advocate for their own allergies/medical needs, especially regarding seafood
- Conduct themselves appropriately and responsibly on off-site field trips

Please note: While Aquarium staff is trained in group management, activity facilitation and considerations for students with special needs, they are not necessarily certified in special education and cannot provide exclusive one-on-one support. If your camper needs individualized support at school or home, they are welcome at camp but must be accompanied by an aide, caregiver or respite provider (at no extra cost to the accompanying adult).

If you have concerns that your child may have difficulty or require assistance with any of these requirements, contact Alexis Berke at aberke@glaquarium.org or (218) 740 - 2013 to discuss options for your camper.

I have read and understand the camp participation requirements.

Camper Name*

First Last

Camper's Gender Pronoun*

He
She
They

Camper's Birthdate*

Grade level camper will be entering in Fall 2023 (must be entering 6th-12th grade to participate in this camp):*

Verify previous participation in SCUBA Camp*

In order to participate in the Advanced SCUBA Camp, campers must have previously participated in a week-long SCUBA Camp at Great Lakes Aquarium in the summers of 2019 or 2022 (alternatively, campers may attend if they possess a Junior Open Water or Open Water certification from a certifying agency - e.g. PADI, TDI, SDI, SEI, IDEA). Please list the year(s) your camper has participated in SCUBA Camp, or their relevant certification information.

NOTE: Campers who are registered for the August 15-19, 2022 SCUBA Camp are welcome to register for this Advanced SCUBA Camp.

Contact Information

Parent/Guardian Name*

First Last

Parent/Guardian Phone Number*

Parent/Guardian Email Address*

Address*

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

Alternate Contact Name*

First Last

Alternate Contact Phone*

Health Form

Great Lakes Aquarium is committed to creating an welcoming and inclusive environment for all campers. Please provide as many details about your camper and their needs as possible so that we can provide a fun, safe and educational camp experience.

Diver Medical Questionnaire*

Recreational scuba diving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. The Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. For your safety, and that of others who may dive with you, please answer all questions honestly.

The participant answered 'no' to all questions on the first page of the questionnaire.
The participant answered 'yes' to one or more questions on the questionnaire. I understand that I will need to consult with a physician before participating in SCUBA Camp. I will bring a copy of the Physician's Evaluation Form (page 3 of the Diver Medical Participant Questionnaire) on the first day of camp.

Allergies*

Does this camper experience an allergic reaction to any of the following? Select all that apply.

Foods
Medications
Environmental factors (insect stings, pollen, etc)
Other
None of the above

Please describe the specific allergen, symptoms, severity of reaction and usual treatment steps:*

Swimming Ability and Fitness*

Although SCUBA diving is not a strenuous activity, swimming abilities need to be sufficient for the amount of time we will be spending in the water. Prior to registering, participants should self-asses that they are able to swim 5 laps, tread water for 5 minutes, and complete a 1-minute survival float.

I confirm that the participant has sufficient swimming ability to participate in SCUBA Camp activities.

Sensory Triggers*

Does this camper experience any sensitivities to sounds, lights, smells, textures or other unique needs that camp staff should be made aware of?

Yes
No

Please describe this camper's sensitivities/triggers and any accommodations camp staff can provide to give your camper the best experience possible. (It may be helpful to share parts of your school's Individualized Education Plan (IEP), school behavior plan, or home routines that support a successful day):*

Would the participant be more successful in camp if they were provided any of the following opportunities?

Great Lakes Aquarium is dedicated to supporting all individuals who would like to attend camp.

I would like to be contacted prior to camp to discuss more details about my camper's health, learning and safety needs.
I would like to make arrangements for my camper to visit the Aquarium before camp to meet camp staff, practice drop-off and pick-up routines, explore the camp room, walk through a schedule of activities and transitions, and/or practice boarding the van for field trips?

(Optional) Will the participant be up to date on vaccinations for COVID-19 at the time of camp?

Yes
No

Disruptive Behavior Policy

Disruptive Behavior Remediation Steps*

A "disruptive behavior" is any action by a camper that disrupts the learning situation, damages the camp environment, disrupts the social interaction of the group, or endangers the camper or others. Aquarium staff will take the following steps in response to disruptive behavior:

Step One: The camper will be asked to change their behavior and reminded that they will be asked to take a break if the behavior continues.

Step Two: If the disruptive behavior continues, the camper will be asked to take a break.

Step Three: If the behavior continues, the camper will take another break, during which they will meet with camp staff. A verbal behavior contract may be agreed upon.

Step Four: If the behavior continues, the participant will leave the activity and be supervised separately by another Aquarium staff member.

Step Five: The camper's parent/guardian will be called to remove the camper from the program for the day.

Great Lakes Aquarium reserves the right to skip action steps in response to severe behavior, including the right to ask parents or guardians make immediate arrangements for the camper to leave the program.

I agree to the disruptive behavior policy.

COVID-19 Policies

Great Lakes Aquarium reserves the right to make updates to these policies prior to the start of camp based on current information in order to best protect staff and campers.

Quarantine and COVID Policy*

Great Lakes Aquarium will use the most updated version of the Minnesota Department of Health's Recommended Decision Tree for People in Schools, Youth, and Childcare Programs to inform decisions about camp quarantine and/or masking in the event of a COVID-19 exposure.

I agree to the quarantine and COVID policy.

Great Lakes Aquarium - Summer Camp Waiver and Release

Great Lakes Aquarium maintains high standards for safety. Please read thoroughly to help us maintain safe and informed programming.

Parent/Guardian Acknowledgment*

I am the parent or guardian of the participant. I understand, answer, and agree to each of the questions in this application on behalf of the participant.

Participant Waiver*

I understand that I (or my child) am participating in the above program at our own risk. I will not hold Great Lakes Aquarium or its officers, directors, employees or volunteers liable for any negligence or alleged negligence or other fault (not including intentional acts) that results in personal injury, death, or property damage during or in connection with the above program. The undersigned, for myself and for my heirs, executors, administrators and assigns, hereby release and forever discharges Great Lakes Aquarium and its officers, directors, employees, and volunteers from all such claims. The waiver will be construed according to the law of the State of Minnesota.

I have read and agree to the participant waiver on behalf of my child.

Medical Release*

I hereby give my permission for Great Lakes Aquarium to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of Great Lakes Aquarium, and grant permission to its representatives to authorize any competent medical professional to do all things reasonably necessary to take care of any injury or sickness.

There is no health insurance or medical coverage provided. Checking the box below acknowledges that the participant/guardian accepts responsibility for payment of any medical treatment which may be required while they are in this program.

I have read and agree to the medical release on behalf of my child.

Location and Transportation Waiver*

While most of the camp activities will be taking place at or on Great Lakes Aquarium property, the group may, at the camp teacher's discretion, walk with the group to nearby locations for additional activities.

This camp may use the Aquarium's 15-passenger van for field trips to destinations which are too distant for walking. Please read this form carefully and be aware that in consideration for the Great Lakes Aquarium providing transportation services in connection with the Summer Camp Program, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages, or loss which you or your minor child/ward might sustain as a result of said services, including but not limited to, vehicle operations and boarding and exiting the vehicle.

I recognize and acknowledge that the Great Lakes Aquarium is neither a common carrier nor in the business of providing transportation services to the public. I further recognize and acknowledge that there are certain risks of physical injury to vehicle passengers, and I voluntarily agree to assume the full risk of any injuries, damages, or loss, regardless of severity that my minor child/ward or I may sustain as a result of participating in any and all activities connected with or associated with receiving transportation services, including, but not limited to, injuries, damages, and loss arising out of negligent operation or supervision of the vehicle. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me and my child/ward) against the Great Lakes Aquarium, including its respective officials, agents, volunteers, and employees (hereinafter collectively referred to as "Parties").

I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising from, connected with, or in any way associated with said transportation services.

I further agree that this agreement shall by governed by the laws of the State of Minnesota.

I have read and fully understand the above waiver and release of all claims.

Photo Release*

I grant permission for Great Lakes Aquarium to use photos and/or video of this child in: (Check all that apply)

Electronic correspondence with parents of other camp participants
Print and digital publications and Aquarium promotional materials
The Aquarium's social media pages
Local news media (newspaper, television, web content, etc.) in the event the program is featured in local news
None of the above

Camp Payment

This payment secures your camper's place in the August 28 - 31, 2023 Advanced SCUBA Camp.

Refund/Cancellation Policy*

I understand that Great Lakes Aquarium will issue a 50% refund for cancellations made up two weeks before the start of the camp. I understand that no refund will be issued if cancellation is made less than two weeks before the start of the camp. I understand that the Aquarium reserves the right to cancel this program in case of an insufficient number of participants or other unforeseeable circumstance. If this occurs a full refund will be issued for all registered participants.

I have read and agree to the refund/cancellation policy.

Are you the recipient of a Great Lakes Aquarium camp scholarship?*

Yes
No

Payment - Scholarship Recipient*

Please enter the amount you will pay for camp (This is the amount indicated in your scholarship award letter).
NOTE: early drop-off is not covered by scholarships, and payment will be calculated separately.

Are you and/or the participant a Great Lakes Aquarium member?*

Yes
No

Not sure? Call to ask at (218) 740 - 2031

Member ID Number*

Aquarium Member Rate*

Price:

Non-Member Rate*

Price:

(Become a Great Lakes Aquarium member today for a discounted rate!)

Early Drop-Off Program*

The scheduled camp day is from 9:00 a.m. - 4:00 p.m. The early drop-off option allows you to drop your camper off as early as 8:00 a.m. for supervised games and activities until the camp day begins.

Yes! I would like to enroll my camper in the early drop-off program ($30).
No, I will drop my camper off between 8:45 and 9:00 a.m. ($0).

OPTIONAL: Mask and Fin Package Add-on*

This set of your very own SCUBA mask and fins will be waiting for you at the Aquarium on the first day of camp. You will be able to use them throughout the week, and then take them home with you on the last day of camp.

This purchase must be made no later than July 1, 2022 to ensure arrival in time for camp.

NOTE: This is an optional add-on. Campers who do not purchase a mask and fin package will have gear provided to them to use at camp throughout the week.

Yes! I would like to purchase a mask and fin package ($100.00)
No, I do not wish to purchase a mask and fin package add-on ($0.00)

Camper's shoe size*

Total

$0.00

Credit Card

American Express

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Summer Camp Registration - Advanced SCUBA Camp - August 28 - 31. 2023

Contact Information

Health Form

Disruptive Behavior Policy

COVID-19 Policies

Great Lakes Aquarium - Summer Camp Waiver and Release

Camp Payment