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2019 Spring Break Camp Registration
The Youth Garden Project is teaming up with the Moab Valley Multicultural Center to offer a full day (9:00am-3:30pm) Spring Break Camp during the vacation week (April 15th-19th) for 1st-4th graders. Each day throughout the week campers participate in a variety of activities that correlate to the days’ theme. Registration is based on a first come-first served policy and space is limited, so be sure to sign-up today! The deadline for registration is April 5th.
Email address *
GENERAL INFORMATION
Child Name: *
Your answer
Grade:
Date of Birth: *
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Parent/Guardian Name(s): *
Your answer
Mailing Address: *
Your answer
Phone Numbers: (include Cell, Home, & Work if applicable!) *
Your answer
E-mail Address: *
Your answer
EMERGENCY CONTACT INFORMATION
Contact 1: *
Your answer
Relationship to Child: *
Your answer
Phone Numbers (include Cell, Home, & Work if applicable!): *
Your answer
Contact 2:
Your answer
Relationship to Child:
Your answer
Phone Number:
Your answer
Individuals OTHER than Parents/Guardians Authorized to Pick-Up My Child; (include Cell, Home, & Work numbers if applicable): *
Your answer
ALLERGY & MEDICAL INFORMATION
List any allergies your child has to food, medications, insects, or other—this includes any dietary restrictions. If none, write none. *
Your answer
List any pre-existing medical conditions your child may have. For example: asthma, hearing, ear infections, visions, fractures or sprains, diabetes, seizures, fainting spells, heart issues, etc. If none, write none. *
Your answer
List any regular medications your child may take. If none, write none. NOTE: YGP staff is unable to dispense ANY medication due to our liability insurance. *
Your answer
PARENTAL/GUARDIAN RELEASES
Please read and agree to the following releases:
PARENT/GUARDIAN AUTHORIZATION: I hereby declare my child to be physically sound, having medical approval to participate in the activities of the Youth Garden Project (YGP). This health history is correct so far as I know and the person herein described has permission to engage in all prescribed activities except as noted. I further understand that neither YGP nor any of its paid staff or volunteers can be held responsible in the event of an accident. I also certify that my child is amenable to discipline and free from habits or attitudes which would make him/her an undesirable participant. *
OFF GROUNDS AUTHORIZATION: I authorize that my child has permission to go off Youth Garden Project (YGP) grounds when necessary to participate in YGP activities, as some activities require the use of a facility or recreational area that is not available at the garden. I agree to hold neither YGP nor any of its paid staff or volunteers responsible for any accident or injury that may occur while my child is participating in a YGP activity that is off YGP grounds. *
EMERGENCY AUTHORIZATION: I authorize any representative of the Youth Garden Project to seek medical attention for my child when immediate medical care is warranted by the circumstances and I cannot be reached, or if under the circumstances there is not time to attempt to reach me because of the nature of the injury or illness. I further authorize the health care professional selected by the agency to provide the necessary care and treatment for my child. *
PHOTOGRAPHY/VIDEO AUTHORIZATION: The Youth Garden Project has my permission to use photographs/videos of my child in any promotional and/or social media material *
STUDENT RELEASE: In consideration of my child’s participation in the Youth Garden Project (YGP) activities, I do hereby agree to hold free from any and all liability the agency and its respective offices, employees, and members and do hereby for myself, my heirs, executors and administrators, waive, release, and forever discharge any and all rights and claims for damages which I may have or which hereinafter accrue to me arising out of or connected with my child’s participation in any of the activities of YGP *
BEHAVIOR POLICY
In order to foster a fun and safe environment, YGP asks that all spring break camp participants follow the C.A.R.E.S. models of behavior expectations.
Outlined below is the model:
•C=Cooperation: follow directions; work as a team.
•A=Attitude: come ready to have fun and try new things!
•R=Respect: follow KYHF&OOTY: “keep your hands, feet, & other objects to yourself.”; kindness and respect should be shown to all campers, staff, and guests at all times; be gentle with all plants and animals; clean up after yourself
•E=Empathy: follow the “golden rule”: treat others as you would like to be treated; lend a helping hand to others
•S=Safety: stay with the group at all times; walk and stay on the designated pathways; wash your hands after visiting animals or before eating; drink lots of water; wear sunscreen.

Anyone who does not follow the above expectations will:
1.Be given one verbal warning and discuss behavior with an instructor.
2. If behavior continues, the camper will be removed from the activity (time-out) with a follow-up discussion with an instructor. If more than one time-out is given in a day, family will be notified.
3. If more than three time outs are given in a day or as deemed appropriate by staff, the camper will meet privately with the Youth Programs Director. In some cases, it may be necessary to call a parent/guardian immediately. Depending on severity, if issues continue, child will be dismissed for the remainder of the day or week. Camp tuition will NOT be refunded.

I have read, understand, and agree to work with my camper to follow YGP's Behavior Policy while at camp: *
PAYMENT INFORMATION
•Cost for camp is $120 for the entire week; however, we have a sliding scale rate of either $30/$60/$90 for qualifying families who apply for a scholarship.
•The $120 payment is due as soon as you submit this registration form with the exception of those applying for a scholarship. To pay online, visit: https://www.youthgardenproject.org/youthcamps/, scroll to the bottom of the page, and click the orange "Pay for Camp" button.
•If you are applying for a scholarship, please submit the application at the same time as registration. We will be in touch the week of April 8th, 2019 regarding your scholarship amount. Payment for camp will be due by the first day of camp: April 15th, 2019.
•If you need to cancel registration for any reason, a refund will be contingent upon YGP’s ability to fill your camper’s spot.
I have read through, understand, and agree to all of the information shared throughout the 2019 Spring Break Camp registration form: *
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