Fort St. Joseph Archaeology Summer Camp Program 
Middle School Students (entering grades 6-8)

July 13-17, 2020 

To apply, please fill out the form below or contact the Niles History Center for an application. Once your application is complete, we will contact you with more information. 

Camper's Information 
Camper's Full Name                                          Nickname                                                                      

Primary Phone                                                                          
School                                                                                Grade Entering 

Parent/Guardian Information 
Parent/Guardian Name                                   Primary Phone 

Address (if different from camper)

Work Phone                                                      Primary Email 

Parent/Guardian Name                                    Primary Phone 

Address (if different from camper)

Work Phone                                                        Primary Email 

Emergency Contact Information: Names and phone numbers of two people to be called in the event that we cannot reach either parent/guardian. 

Emergency Contact Name                              Phone 

Emergency Contact Name                              Phone 

Additional Information 
Is there any person who does not have permission to pick up camper? 

Does your child have any allergies and/or intolerances to food, medication, or any other substance?  If so, please describe below. 

Please note if there are any issues that may inhibit full participation in the camp. 

Will your child need to take any medicine while at camp? If yes, we will send you another form to complete. 
Yes    No 

I understand and agree that my child's participation in the Fort St. Joseph Archaeology Summer Camp Program, due to photographic documentation of our findings and public events, may result in their, and any invited guests, picture being taken and published for promotional purposes.   Yes    No 

Would you like us to contact you about scholarship availability?  Yes      No 

Additional Forms   -  please sign the two additional forms and attach below 
Medical Release and Waiver Forms