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Camp Kookooskoos - Camper Registration Form  2024
 CAMP IS FULL,  REGISTRATION IS CLOSED.  


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CAMPER DETAILS
Child's Last Name *
Child's First Name  (use nickname if preferred) *
Is this camper a registered Teaneck Public Schools' student?  (Charter school students are NOT TPS students) *
Family Home Address (include street address, apt # & town) *
School child will attend in September 2024 *
Grade child is entering in September 2024 *
Age as of June 24, 2024 *
Birthdate *
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Gender *
Is your child required or recommended to attend summer school during the same dates that camp is in session?  If so, we ask you to refrain from registering at this time.  Contact our office first to discuss logistics. *
T-shirt size   Each camper will receive 2 t-shirts.  Additional shirts can be ordered through our store at MySchoolBucks ($10 each) *
Does this child have a sibling/s in the program, if yes, sibling/s' name/s
CAMPER ENROLLMENT INFORMATION - TEANECK RESIDENTS
Please choose either all SESSIONS or the 1 or 2 particular sessions that your child will attend.  Please note, there are two sections, one for K-4 & one for 5&6.  Please fill out the appropriate section based on your child's grade.
K-4 GRADE CAMPERS - tell us which sessions your child will attend. You can choose more than one.
5&6 GRADE CAMPERS - tell us which sessions your child will attend.  You can choose more than one.
CAMPER ENROLLMENT INFORMATION - NON-RESIDENTS
Please choose either all SESSIONS or the 1 or 2 particular sessions that your child will attend.  Please note, there are two sections, one for K-4 & one for 5&6.  Please fill out the appropriate section based on your child's grade.
K-4 GRADE CAMPERS - tell us which sessions your child will attend. You can choose more than one.
5&6 GRADE CAMPERS - tell us which sessions your child will attend.  You can choose more than one.
ADD-ONS (Before-Care, After-Care & Kosher Lunch)  
Please let us know if you need before -care, after-care or kosher lunch.
Before & After Care
Clear selection
Kosher Meal  Plan
Clear selection
PARENT/GUARDIAN CONTACT INFORMATION
Contact #1 will be our main contact for both day to day issues and all billing/payment issues. Contact # 1 will receive our email blasts.  It's helpful for us to have a second contact as well.
# 1 Parent/Guardian Contact Name *
# 1 Contact Cell Phone Number (please use dashes, ex. 201-555-5555) *
# 1 Contact Work Phone Number (please use dashes, ex. 201-555-5555)
# 1 Contact's Email Address (this email will be used for email communication and email blasts.  Please only include one email address in this field). *
#2 Parent/Guardian Contact Name
# 2 Contact Cell Phone Number (please use dashes, ex. 201-555-5555)
# 2 Contact Work Phone Number (please use dashes, ex. 201-555-5555)
CAMPER MEDICAL SECTION
Based on your responses in this section, there may be a follow up form or other documents to submit.
Does your child have any allergies? *
Allergy Information
Please complete this section if you answered YES.  You can skip if you answered NO.
Please list your child's allergens and triggers
What is your child's reaction to these allergens?
Does your child require an inhaler? *
Will any medication be required during camp hours? *
Does your child require an EPI pen? *
Does your child have any special dietary restrictions or needs?  If so, please explain.
Does your child have any limitations physical or otherwise that we should know about?
Your child's Doctor's Name *
Doctor's Phone Number (please include dashes, ex. 201-555-5555)
Doctor's Affiliated Hospital
Emergency Contact.  Please include another contact for us in the event of an emergency if Contact 1 & 2 cannot be reached
Emergency Contact Name
Emergency Contact Cell Number (please include dashes, ex. (201-555-5555)
CAMPER INFORMATION
Tell us a bit about your child!  We recognize that every child at camp has different needs.  Help us ensure we can make your child's experience the best that it can be.
Does your child have a nick-name they prefer to be called?
Is this your child's first camp experience?
Clear selection
If your child has attended camp, which camps and did they enjoy their experience?
Tell us about your child's swimming skills
Clear selection
Give us more detail about how comfortable your child is with swimming.   Can they go above their head, swim under water, etc.
What are some of your child's favorite activities?
Is there anything specific that your child's counselor should know about your child's temperament, fears, likes, dislikes?
Does your child become frustrated easily, if so, how do they handle that (tantrum, get quiet, etc)?
What are your goals for your child this summer?
Have any major changes occurred recently that may effect your child's behavior?
Does your child have any specific special needs (social, medical, emotional or learning) that it would be helpful for us to know about?
Parent/Guardian Authorization  - By signing you are granting acknowledgment & full permission for all of the below.
1.  I understand the rules and procedures will be sent in a separate document as we get closer to start date.
2.  In the event of an emergency, I give permission to have my child treated by medical personnel.
3.  I give permission to have camp staff talk to school personnel about my child, if necessary.
4.  Permission is granted for Camp K to take my child on all trips (walking and by bus) including Votee pool and splash pad.
5.  Permission is granted for my child to swim at Votee Pool.*
6.  Permission is granted for photos to be taken of my child for social media and advertising purposes.**
7.  I understand fees are non-refundable.
8.  I understand there will be no refunds for days missed, for a suspension due to behavioral issues or a forced shut-down due to any emergency closing.
9.  I have read and understand the behavior expectations for my child during camp.  I understand my child could be suspended or permanently removed from the program. 
    
* You must contact our office if you prefer your child NOT swim at Votee Pool.
** Please contact our office if you prefer we DO NOT take photos of your child.
Parent/Guardian Signature *
Today's Date
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UPON COMPLETION FOLLOW THIS LINK TO PAY YOUR REGISTRATION FEE + $300 DEPOSIT at our online payment vendor MySchoolBucks
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