2025 Solid Waste Division Environmental Summer Camp Registration Form

City of Jackson, MS Solid Waste Division Environmental Summer Camp Registration Form

Theme: "Nurturing Nature"

June 16 - 20, 2025

For Jackson Public School Children Ages 6-12

The Solid Waste Division Environmental Summer Camp with JPS students will be returning this summer, June 16-20. This is a fun and engaging program for kids, covering

Waste Management & Recycling
Water Conservation & Aquatic Life
Planting & Gardening
Eco-Art & Upcycling Projects

Participant Information

Child's Full Name(Required)

Date of Birth(Required)

Age (of June 16, 2025)(Required)

School Name

Grade Level

Parent / Guardian Information

Parent / Guardian Name(Required)

Relationship to Child(Required)

Phone Number(Required)

Alternate Phone Number

Email(Required)

Address(Required)

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

Emergency Contact Information

(If different from parent / guardian)

Emergency Contact Name(Required)

Relationship to Child(Required)

Phone Number(Required)

Medical Information

Allergies

Does your child have any allergies? If yes, please specify.

Medical Conditions

Does your child have any medical conditions we should be aware of? If yes, please explain.

Medications

Does your child require any medications during camp hours? If yes, please list medications and instructions.

Child's Interests in Nature

What do you enjoy most about nature and the environment?(Required)

Exploring outdoors (hiking, walking, etc.)

Learning about animals and plants

Recycling and protecting the environment

Gardening and growing plants

Water activities (ponds, lakes, etc.)

Other

(Check all that apply)

In a few words, tell us what you love about nature and why you're excited to join the Environmental Summer Camp:(Required)

T-Shirt Size (Please select one)(Required)

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Parental Consent & Liability Waiver

I give permission for my child to participate in the City of Jackson Solid Waste Division Environmental Summer Camp. I understand that my child will engage in outdoor and educational activities related to environmental conservation, waste management, and sustainability. I acknowledge that my child must follow all camp rules for safety and participation. I release the City of Jackson, its employees, and affiliates from any liability related to my child’s participation.

Parent / Guardian Signature

Date

Photo / Media Release

I give permission for my child’s photo/video to be used for promotional or educational purposes by the City of Jackson Solid Waste Division.