Camp Sol of the Deaf
3506 Palisade Avenue
Union City, NJ 07087
www.campsolofthedeaf.org

One camper per form / Make copies as needed / Please print all Information
Email address *
Camper Information:
Camper's Full Name:
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade next fall
School
Your answer
Gender
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
County
Your answer
If camper does not live with both parents, who has legal custody?
Your answer
Physical custody
Your answer
Has the camper attended this camp before/when?
Your answer
Any other camp before/where?
Your answer
Camper T-shirt size:
Parent /Guardian 1 Full Name:
Your answer
Relationship to camper
Your answer
Preferred Phone #
Your answer
Alternate Phone #
Your answer
E-Mail
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
County
Your answer
Parent/Guardian 2 Full Name
Your answer
Relationship to camper
Your answer
Preferred Phone #
Your answer
Alternate Phone #
Your answer
E-Mail
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
County
Your answer
Three options to pay
Personal Check
A non-refundable deposit of $75.00 is required for each application.

Make check payable to:

Camp Sol of the Deaf
3506 Palisade Avenue
Union City, NJ 07087

Enclosed: # ________ Amount: $ ____________
Your answer
Deposit, Fees &/or Refund:
Rules of acceptance and participation in Camp Linwood’s programs are the same for everyone without regard to race, color, religion, sex, disability, or national origin. It is understood that all campers will be treated as individuals and respect shown for reasonable differences in tastes, preferences, abilities, and range of behavior patterns. Camp fees are non-refundable if a camper leaves due to homesickness, dismissal or voluntary withdrawal. Camp Sol of the Deaf reserves the right to dismiss a child from camp whose special needs we are not able to meet or whose conduct is not in the best interest of the total camp, without refund.

Deposit must accompany registration form to be valid. Fees less any scholarship awarded, must be paid a minimum of two weeks prior to camp participation. Refunds are provided in the event of serious illness or mandatory summer school at-attendance which can be shown to prohibit rescheduling the session to a later date. No refund is given if a child is dismissed from camp for disciplinary reasons.
PERMISSION FOR ENROLLMENT OF MINOR (< AGE 18) & RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
I am an adult over the age 18 years of age and am duly authorized to grant permission for (child’s name): ________________________________________ to participate in all Camp Sol of the Deaf (CSD) activities and to release the ZDC and its staff members from all liability for any injury, loss and/or damage connected in any way whatsoever with participation in CSD activities whether on or off the CSD’s / YMCA’s premises. I recognize the fact that there is an inherent danger associated with participating in the activities of CSD. I certify that (child’s name) ________________________________ is capable of participating in an active recreation experience. I understand that at any time he/she may opt out of an activity. I understand that even with every reasonable precaution is taken, accidents can sometimes still occur. I agree to hold harmless and blameless and indemnify CSD, employees (exempt and/or nonexempt), volunteers, Board of Trustees, independent contractors, sub-contractors, persons related, friendly, acquainted, visiting, associated, hired or trespassing on behalf of the CSD including their heir(s), executor(s)/executrix(s) and administrators because of, including but not limited to any accident, event, Act of God, injury or anguish, physical or otherwise, which I might receive or experience using or accessing or being within close proximity of the CSD / YMCA of Newark & Vicinity’s Camp Linwood MacDonald facilities. This extends to permitted and non-permitted access/use/proximity as well as authorized and unauthorized access/use/proximity.
Child's name : Signature here
Your answer
Child's name: Signature here
Your answer
I have read and am voluntarily signing to indicate my agreement and authorization
Signature of Parent or Legal Guardian
Your answer
Print Name of Parent or Legal Guardian
Your answer
Date
MM
/
DD
/
YYYY
Relationship to child
Your answer
PERMISSION TO VIDEOTAPE AND PHOTOGRAPH
● I hereby grant permission for (child’s name) _________________________ to be videotaped and/or photographed while participating in programs and activities of CSD. It is my understanding that videotaping and photographs will be used for educational, training and promotional purposes only. I may revoke this permission at any time by sending a letter to CSD with a copy of a photograph for identification purposes to minimize the accidental use of his/her image.
Signature of Child's name here:
Your answer
● I do not grant permission for (child’s name) _______________________ to be videotaped and/or photographed while participating in programs and activities of CSD. I have provided a labeled photograph for identification purposes to minimize the accidental used of his/her image.
Signature of Parent or Legal Guardian
Your answer
Print Name of Parent or Legal Guardian
Your answer
Date
MM
/
DD
/
YYYY
Send completed form and a check to:
Camp Sol of the Deaf
3506 Palisade Avenue
Union City, NY 07087

(VP) 646-559-3317 Camp Registrar: Maleni Chaitoo Email: zdcmalenichaitoo@gmail.com

We are in process of applying for 501(c)3 nonprofit organization
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy