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Summer Camp Registration-Youth Garden Project (2019)
Please fill out this form in its' entirety.
Email address *
GENERAL INFORMATION
Camper Last Name: *
Your answer
Camper First Name: *
Your answer
Date of Birth: *
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Age: *
Your answer
Sex: *
Parent/Guardian(s) Last Name: *
Your answer
Parent/Guardian(s) First Name: *
Your answer
Phone Numbers: (include Cell, Home, & Work if applicable!) *
Your answer
Mailing Address: *
Your answer
EMERGENCY CONTACT INFORMATION
Emergency Contact #1 and Relationship to Child: *
Your answer
Phone Numbers (include Cell, Home, & Work if applicable!): *
Your answer
Emergency Contact #2 and Relationship to Child:
Your answer
Phone Numbers (include Cell, Home, & Work if applicable!):
Your answer
Individuals OTHER than Parents/Guardians Authorized to Pick-Up My Child; (include Cell, Home, & Work numbers if applicable): *
Your answer
2019 CAMP SELECTIONS
In an effort to provide more summer programming, we are continuing our partnership with Canyonlands Field Institute. This year, we will be offering an additional off-site camp during Week 4 and Week 7. Registration for this camp is $150 per camper per session and only offered to youth entering grades 4th-6th or ages 9-12.
Sessions are filled on a "first come first served" basis. Select the following weekly sessions that your camper would like to attend. NOTE: there is no camp July 1st-5th! *
Required
ALLERGY & MEDICAL INFORMATION
Health Insurance Provider and Policy Number (if none, write none): *
Your answer
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
Will your child need a life jacket to swim in the Mill Creek swimming hole? *
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 summer 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: Cost for camp is $130 per child per session.
•DEPOSIT: a $30 good faith deposit per camper per session is due at the time of registration. Deposits are only refundable if you cancel 30 DAYS PRIOR to the session start date. The remaining balance for each session is due two weeks prior to the session start date. You will receive reminders via e-mail for each payment. Once tuition has been paid in full a refund will be contingent on YGP's ability to fill your campers spot.
•SCHOLARSHIPS: all families are encouraged to apply for a scholarship! We are able to offer a sliding scale rate of either $30/$65/$90 per child per session for qualifying families. We will be in touch in regards to the amount awarded during the week of May 27th (or sooner!)
I have read through, understand, and agree to all of the information shared throughout the entirety of this registration form: *
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