Summer Ecology - Week 1 (Entering grades 2nd & 3rd) 6/29 to 7/3

2026 SEP Week 1 for 2nd and 3rd

"*" indicates required fields

Please double check all information is correct prior to submitting application. Please do not use autofill for this application.

Your Name (Parent/ Guardian)*

First Last

Cell Phone #*

Home/Work Phone #

Email*

Enter Email Confirm Email

All confirmations will be sent to this email address, including any changes in the weeks schedule, or updates on the program. Please use an email that you regularly check and make sure that it is typed correctly.

Additional Email (Guardian/Parent)

Enter Email Confirm Email

Mailing Address*

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

Child's Name*

First Last

Child's Nickname (if applicable)

Nickname

This will be the name that will be used for nametags and attendance if this section is completed.

Child's is entering grade in September 2026:*

Child's Date of Birth*

Child's Shirt Size*

Youth S: 6/8

Youth M: 10/12

Youth L: 14/16

Youth XL: 18/20

Adult S

Adult M

Are you a 2026 QWR Member?*

Yes

Memberships are valid through the calendar year (Jan 1 to Dec 31). If you were a member last summer and haven’t renewed, you can renew your membership online today. Please note that you need a current Family level membership or higher to receive the priority & discounted registration for Summer Camp. Family Memberships are only valid for the immediate family (i.e Parents and Children – not Grandchildren). To become a member visit https://quoguewildliferefuge.org/get-involved/become-a-member-today/ or call 631.653.4771. You can become a member at any time.

Member Registration Fee (SEP Week 1)*

Price:

NON Member Registration Fee (SEP Week 1)*

Price:

Non-members are welcome to MUST register after 05/11/2026 OR become a member today. To become a member visit https://quoguewildliferefuge.org/get-involved/become-a-member-today/ or call 631.653.4771. You can become a member at any time.

Total

Payment Type*

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Enter the name on the check below

Send checks to PO Box 492, Quogue NY 11959 – *Check must be postmarked within one week of this form submission and received before camp begins to ensure your reservation.

Refund Policy*

I understand and will comply with the Refund Policy below

By selecting this box, I am confirming that I have read, understand, and will comply with the following Refund Policy: A 50% refund will be granted if cancellations are received at least 30 days prior to the start of the camp session. There will be NO refund if the cancellation occurs within 30 days of the first day of the session, therefore please choose your sessions carefully and mark them in your calendar. Cancellation requests must be made by email to: Programs@QuogueWildlifeRefuge.org *(Strictly enforced)* Switching camp weeks (if available) will be subject to an additional $50 processing fee per application.

Health and Emergency Contact Information

You will be listed as the 1st Emergency Contact. ** PLEASE LIST TWO EMERGENCY CONTACTS IN ADDITION TO YOURSELF. If listed, these contacts will be approved for pick-up and must show a photo ID at camp pick-up.

Emergency Contact Name #1*

First Last

Emergency Contact Phone #*

Relationship to Child*

Emergency Contact #2*

First Last

Emergency Contact Phone #*

Relationship to Child*

Approved Persons for pick-up (names must match the persons photo ID at pick-up) – Please list people who will be or will likely be picking up your child.

example: Babysitters, Family Friends, Grandparents. Must show a photo ID at the time of pick-up

*** Please List Your Child’s Medications & Allergies Below****

Any other Medical or Behavioral History (restrictions/limitations, special needs, dietary concerns, etc…):*

If your child attends school with an aid, please inform Quogue Wildlife Refuge staff. At this time, we are not able to provide 1:1 supervision and therefore an aid must be provided. Please contact Refuge staff, as information on the aid must be provided before the start of your child’s camp week (as per Suffolk County Health Department). Please send or attach any treatment, care, and behavioral plans if applicable.

Please Upload a Copy of Your Child's Vaccination Record (General Vacc Record, NOT COVID IMMUNIZ CARD)*

Drop files here or

Max. file size: 2 GB.

We are required by the NYS Health Department to have an up-to-date copy of your child’s vaccinations on file. We do not accept registrations without this form. Usually called a “School/Camp Form” from pediatrician. Please upload a PDF or JPEG of the file here. If the file is too large, please try shrinking it or taking a clear photo of it, then upload. We only need your child’s general vaccination record, NOT the Covid immunization card. Email programs@quoguewildliferefuge.org if you are having issues uploading a file to this form.

Parental Consent – Emergency Statement – (Sign Agreement to Below Statement)*

This form will be valid for 2026. I hereby grant permission for my child (named above) to attend the Quogue Wildlife Refuge Summer Ecology Camp and participate in all activities listed. In the event of a medical or weather emergency and/or the inability to contact the designated guardian(s) in such an event, I agree that the Quogue Wildlife Refuge Staff may take such emergency measures, including transportation, as they deem appropriate and shall notify the parent and legal guardian as soon as possible. Quogue Wildlife Refuge reserves the right to use photographs/ videos taken at camps, programs and events for use on our website, publications, and social media.

Summer Ecology – Week 1 (Entering grades 2nd & 3rd) 6/29 to 7/3

2026 SEP Week 1 for 2nd and 3rd

Please double check all information is correct prior to submitting application. Please do not use autofill for this application.

Health and Emergency Contact Information