2017 TPP ReFuel Summer Camp Registration for Elementary-Aged Students
Camp runs for 5 weeks from June 26- July 28th from 8:30am-3pm. The child must be entering 1st-6th grade to be eligible. There is no early drop-off for camp. Camp costs $60/week. Lunch and snack ARE provided. Please pack a labeled backpack and water bottle daily for your child. PAY FOR 4 WEEKS IN FULL BY February 1st 2017 and receive the 5th week of camp for free!! That's $240 for 5 weeks of summer camp (incentive does not apply to aftercare). **Please note your child is not considered registered until the $10 payment is made.

**Aftercare is available daily until 6pm for an additional $35/week.

Child's First Name
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Child's Last Name
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Child's Gender
Child's Date of Birth
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Grade Enterring in September 2017
Street Address
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City
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Zip
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Mother's Name
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Mother's Address
Mother's Main Phone
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Mother's Email
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Father's Name
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Father's Address
Father's Main Phone
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Father's E-mail
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Weeks Attending
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Aftercare Needed $35/wk. *Currently, our aftercare is full. If you would like to be added to the waiting list, please email darlene@thephiladelphiaproject.com
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Child's Allergies
Activity Restrictions
Insurance Policy #
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I give The Philadelphia Project permission to use individual photos or video of my child for marketing and creative purposes. (Must check yes in order to participate)
Liability Release I agree to waive my claim for liability against ReFuel and The Philadelphia Project, including its employees and representatives, and release them from liability in connection with transportation to ReFuel. Further, I assume full responsibility for any damage to persons and/or property caused by my child.
Medical Emergency Release In case of emergency or injury to my student, I hereby authorize the school to act in the best interest of my child. I further consent and will be responsible for any medical and/or dental treatment that may be advisable at the discretion of any physician or dentist. I understand that I will be personally notified if it becomes necessary for my child to be returned home and/or require health treatment.
Required
Activities Authorization My Child indicated on this form has my permission to attend all activities sponsored by ReFuel and The Philadelphia Project (TPP) from June 26, 2017 to July 30, 2017. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases TPP and its staff of any liability against personal losses of named child.
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Child's T-shirt Size
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