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 with all the places our imaginations will take us.
To register, simply fill out this form and pay the $100 non refundable security deposit by April 16, 2020.
Save $50 if you pay in full for the entire 8 weeks by May 30th
We will only accept 40 kids a day for a 10 to 1 adult ratio
Artists Adventures (9-12 years old) we are only accepting 10 kids per day for a 10 to 1 adult ratio
Here's to a fun summer!
Payment Information- we will bill you once we receive how you want to pay
Time: 9:00-3:00 p.m.
This year we are offering two group:
Kids Project Camp- 5-8 years old
Artists Adventures 9-12 years old
Cost: Full Day $1,000 for 1 child- $900 each additional child *drop off begins at 8:30a.m.
-2 week session for $300- $250 for each additional child
-6 week Session- $800 for 1 child- $750 for each additional child
Registration & Payment
8 weeks- $1,000
8 weeks sibling- $950
6 week-$800- contact Ellyzabeth with your dates
6 week- $750 sibling- contact Ellyzabeth with your dates
Session: I: June 22-July 3rd- $300
Session: I: June 22-July 3rd- $250- Sibling
Session II: July 6-17th-$300
Session II: July 6-17th- $250 Sibling
Session III:July 20- July 31st- $300
Session III:July 20- July 31st-Sibling $250
Session IIII: Aug. 3rd-14th- $300
Session IIII: Aug. 3rd-14th- Sibling $250
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
Exteneded Care-$75 a week $600
Extended Care- $50 a week sibling $400
Extended Care 10 Visits- $200
Before Care-$50 a week- $400
If I needed, I'll pay for it
I would like to pay:
Deposit- $100- per child
Two Payments (minus deposit- June 1st, July 15th)
Pay in full (Save $50 ff you pay in full for the entire 8 weeks by May 30th , only for 8 weeks)
I need another option- please contact me. CDE will work with your needs
Select how you would like to pay
Paypal- friends and family transfer
1. Child's Name
2. Child's Name
3. Child's Name
Prefer not to say
Prefer not to say
Prefer not to say
Main Cell Phone Contact
Child Lives with
ADULTS AUTHORIZED TO PICK-UP MY CHILD/EMERGENCY CONTACTS OTHER THAN PARENT/GUARDIAN (minimum of 2 are required)
Relationship to child
2. Relationship to child
2. Phone Number
UNAUTHORIZED PICK-UP: People who CANNOT pick up your child from CDE program:
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.
Doctor's Name and Phone Number
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?
Will your child need to take medication? No or Yes (explanation):
Are there allergies that we should be aware of? No or Yes (explanation): Allergic reaction (describe)
Does your child require a medication, due to disability, in order to participate? No or Yes (explanation):
Are there activities that your child should be exempt from due to health reasons?
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?
Does your child have any fears that we should be aware of?
Is there anything that we need to know about your child so that they many have a happy and productive camp experience?
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
-Walking Field Trips
-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
At Chicago Danztheatre Ensemble, we strive to create an equitable and empowering space for our artists, administrators, teachers, and audiences. We aim to build a platform for the voices of the diverse communities we serve. All are welcome.
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
A copy of your responses will be emailed to the address you provided.
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