Kids Project Summer Camp Registration Form
Thank you for signing your child up for Kids Project Summer Camp. This is going to be one fun summer going back in time to explore artists, dinosaurs, decades of music and what ever else our camps imagine.

To register, simply fill out this form and pay the $100 non refundable security deposit by April 16, 2019.

We will only accept 44 kids a day for a 11 to 1 adult ratio

Here's to a fun summer!

Email address *
Payment Information- we will bill you once we receive how you want to pay
Full day camp is available for ages 5-12 years old Time: 9:00-3:00 p.m.
Half day camp is available for ages 4-6 years old Time: 9:00-12:00 p.m.

Cost: Full Day $1,000 for 1 child- $900 each additional child *drop off begins at 8:30a.m.
Half Day $475 for 1 child (4yrs may attend full day with approval)
2 week session for $300- $250 for each additional child
6 week Session- $800 for 1 child- $750 for each additional child

Registration & Payment
Before and After Care Options
Before Care begins at 8am- camp drop off starts at 8:30am
After Care begins at 3:15pm until 6:00pm
Before Care
I would like to pay:
Payment Options
Select how you would like to pay
Contact Information
1. Child's Name
Your answer
2. Child's Name
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3. Child's Name
Your answer
1.Age
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2.Age
Your answer
3.Age
Your answer
1.Gender
2.Gender
3.Gender
1.Birthdate
Your answer
2.Birthdate
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DD
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YYYY
3.Birthdate
MM
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DD
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YYYY
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Main Cell Phone To Contact
Your answer
Name: Parent/Guardian#1:
Your answer
Parent/Guardian#1: phone:
Your answer
Parent/Guardian#2:
Your answer
Parent/Guardian#2: phone:
Your answer
Child Lives with
ADULTS AUTHORIZED TO PICK-UP MY CHILD/EMERGENCY CONTACTS OTHER THAN PARENT/GUARDIAN (minimum of 2 are required)
1. Name
Your answer
Relationship to child
Your answer
Phone
Your answer
2. Name
Your answer
2. Relationship to child
Your answer
2. Phone Number
Your answer
UNAUTHORIZED PICK-UP: People who CANNOT pick up your child from CDE program:
Your answer
AUTHORIZED PICK-UP/EMERGENCY PICK-UP: I, agree 
to pick up my child and be contacted in the event of an emergency from the camp. In doing so, I relieve the Chicago Danztheatre Ensemble, its employees and agents from all responsibility for my child after he/she has been released from the program. Attempts will be made to reach the parent/legal guardian.
Medical Information
Doctor's Name and Phone Number
Your answer
The following questions are asked so that we may best serve your child in programs. Any information that you choose to disclose is confidential.
Are there any health conditions that you would like us to be aware of?
Your answer
Will your child need to take medication? No or Yes (explanation):
Your answer
Are there allergies that we should be aware of? No or Yes (explanation): Allergic reaction (describe)
Your answer
Does your child require a medication, due to disability, in order to participate?
No or Yes (explanation):
Your answer
Are there activities that your child should be exempt from due to health reasons?
Your answer
Are all immunizations up to date?

MEDICAL RELEASE: I do hereby give permission for the Chicago Danztheatre Ensemble staff to transfer child named above off property for the purpose of medical care as deemed appropriate by the Director and in the event that I cannot be reached in an EMERGENCY, I hereby give my permission to the physician selected by the Director, to hospitalize, to secure proper treatment for and to treat as appropriate my child named above.
Please describe your child’s interactions with children of the same age. How would you describe your child’s personality?
Your answer
Does your child have any fears that we should be aware of?
Your answer
Is there anything that we need to know about your child so that they many have a happy and productive camp experience?
Your answer
AUTHORIZATION FOR SUNSCREEN: By signing this form, I acknowledge that I will sufficiently apply sunscreen to all of my child’s exposed skin, and agree that Chicago Danztheatre Ensemble Staff may reapply the spray sunscreen that I provide, labeled with my child’s name.
PARTICIPANT INFORMATION PACKET
-Character Contract
-Talent Release
-Walking Field Trips
-Financial Agreement
-Facility User Aggreement
CDE CHARACTER CONTRACT

If this contract is broken or if there is a conflict/interaction that involves strong feelings or serious negative behaviors the following steps will be taken.

Step 1: CDE staff will talk with campers in order to acknowledge feelings, gather information and create a plan to repair any harm that has been caused.

Step 2: If negative behavior persists or the plan to repair harm is not followed, parents will be asked to come to the program to discuss the issues and work toward a solution together with their child and CDE staff.

Step 3: CDE staff will monitor behavior closely and provide regular feedback to the camper and their parents.

Step 4: If the problem persists or camper does not follow the plan created and agreed upon, the parent may be contacted immediately to pick up their child from camp. The following morning, parents, staff and child will meet to discuss any additional supports that the child might need to be successful in the program.

Step 5: If the prior interventions are not successful AND youth behavior is impacting the physical or emotional safety of themselves, CDE staff or other campers, the child may be dismissed from the program for the remainder of session.

We agree to CDE's Character Contract
TALENT RELEASE FORM-I give permission for my child, to be photographed, videotaped or interviewed during Chicago Danztheatre Ensemble’s residency programs. My child’s image may appear in print or online promoting the CDE’s activities and programs. I understand that my child’s name will not be used to identify my child. This permission form will be kept on file in the CDE’s office. If I would like to withdraw my permission, I may do so at anytime.
I hereby given permission to participate in spontaneous, walking field trips throughout the summer. I understand that each trip will take place in the area, weather permitting, and the teachers will always accompany the children
FINANCIAL AGREEMENT: I understand that there is a $25 service charge assessed by CDE on all returned checks and declined monthly credit card/checking account drafts. I understand that I will receive written notice in advance of any change in the date of the payment plan or for any change in the amount due, and I authorize CDE to use such changed date or amount after the written notice is sent to me, unless I cancel this authority and the Payment Plan as provided above. I understand that it is my responsibility to update my contact information when there is a change of name, address, or financial institution or account.
FACILITY USER/FIELD TRIP AGREEMENT:
I agree to follow all rules and regulations of the Chicago Danztheatre Ensemble and Wicker Park Lutheran Church while in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program and understand and agree that I may be expelled at any time, with no refund of any monies paid, for failure to abide by such rules and regulations.

IN CONSIDERATION OF BEING PERMITTED TO UTILIZE THE FACILITIES, SERVICES AND PROGRAMS OF THE CDE FOR ANY PURPOSE, INCLUDING BUT NO LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE CDE WITHOUT RESPECT AS TO LOCATION, I HEREBY AGREE TO THE FOLLOWING:

I UNDERSTAND THAT ACTIVITIES AT THE FACILITY OR ELSEWHERE, INCLUDING USE OF EQUIPMENT AND PARTICIPATION IN PROGRAMS, CAN INVOLVE MOVEMENT AND STRAIN.

I ALSO UNDERSTAND THAT PROGRAM ACTIVITIES INCLUDE FIELD TRIPS TO LOCATIONS OUTSIDE THE CDE’S PREMISES, AS DESCRIBED IN DETAIL IN THE PROGRAM MATERIALS, AND THAT PUBLIC OR PRIVATE TRANSPORTATION MAY BE UTILIZED TO TRANSPORT PARTICIPANTS TO AND FROM THESE FIELD TRIP LOCATIONS.

I, FOR MYSELF, ANY PERSONAL REPRESENTATIVES, ASSIGNS, HEIRS AND NEXT OF KIN, HEREBY FULLY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE CDE its operating centers, their respective directors, Board of Managers, Trustees, members, volunteers, employees or agents (the “Releasees”) and each of them from any and all claims for injuries, damage or loss that I or my minor child/ ward may incur whether in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program affiliated with the CDE premises, except for any injury, damage or loss that is caused solely by the CDE’s gross negligence.

I further expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Illinois and if any portion thereof is held invalid, it is agreed that the remaining Agreement shall, notwithstanding, continue in full legal force and effect.

THIS AGREEMENT APPLIES TO ALL PAST, PRESENT AND FUTURE VISITS AND USES BY ME TO ANY CDE FACILITY OR PROPERTY.

I HAVE READ AND VOLUNTARILY SIGNED THIS FACILITY USE/FIELD TRIP AGREEMENT, and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE AGREEMENT. THIS AGREEMENT CONTAINS A WAIVER AND RELEASE.

By filling out your name below you are entering an agreement with CDE
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A copy of your responses will be emailed to the address you provided.
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