Registration Forms for the Environmental Science Program

If you have already sent in your registration form to the Program for summer of 2018, please send in the following health and consent forms for the Newton Health Department and the Commonwealth, to complete the registration process. These forms are necessary for our annual review with the City Health Department, and required for your student's participation in the program.

You can download these forms as PDF files and print them out (links open in new window):

• Consent Form / Release from Liability (1 page)
• Photo/Video release form (1 page)
• ESP Immunization Record (Staff & Students under 18) + Special Activities Permission Form (3 pages)

• Authorization to administer medication to a camper form + signature page (1 page)

Please Note about that last form: the Department of Health expects the Program to have the "Authorization to administer medication" form in our records for ALL students when our records are reviewed. Please complete that form, and include it with your other forms, even if you just write "Taking no medications". This will help to make our review with the Department of Health successful. Thank you.

Mail the completed forms (total of six pages) and a doctor's exam sheet (dated within past 2 years) to:

David Backer, Executive Director
Environmental Science Program
P.O. Box 600292
Newton, MA 02460

Questions? Please call 617-447-9317

Thank you for registering for the Environmental Science Program!