Camp Registration
Fill out this form: one per camper.
Email address *
Camper Name *
Your answer
Which camp are you in enrolling in? *
Required
Camper's Date of Birth *
MM
/
DD
/
YYYY
Parent/ Guardian Name *
Your answer
Address *
Your answer
Email Address
Your answer
Phone Number(s) *
Your answer
Additional Emergency Contact: Name and Phone Number *
Your answer
Medical Information: Please list any allergies, or medical conditions, and medications (relevant to time at Camp) *
Your answer
Pediatrician and Phone Number *
Your answer
Insurance Company, Policy Number, and Policy Holder *
Your answer
All campers are welcome! Having pertinent information about behavioral or learning needs (i.e Autism, ADD/ADHD, dyslexia, etc) will help us ensure that your camper has the best experience possible.
Your answer
Agreement: Please read all of the following statements and check the box.If the Center considers it to be in the best interest of the Center, I understand the Center may suspend or dismiss my child. *
Required
I understand my child may not attend the Center when the child is suspected of being in a contagious state. I agree to remove my child from the Center immediately upon notification of said condition. Children not removed within one hour of notification will be charged late pick up fees. Children sent home in a contagious state must be symptom free for 24 hours and may not return the following day at a minimum. *
Required
I understand medication will only be given to my child when the proper authorization form is completed daily for the times specified by the Center. Prescription medications must be in original containers with prescription label and must be prescribed for my child. Sample medications from doctors must be accompanied by written prescription from the doctor. Dosages must coincide with label unless doctor’s note specifies differently for both prescription and over the counter medicine *
Required
I will label all my child’s belongings and will not hold the Center responsible for lost or damaged items. I will not send in items of special value. *
Required
I hereby grant permission for my child to be included pictures and video connected with the Center’s program. *
Required
The Center is required by law to report suspicion of child abuse or neglect. *
Required
I will not hold the Center liable for incidents beyond their control. I am responsible for my child’s medical expenses incurred as a result of injuries or illnesses. *
Required
I hereby grant permission for the staff to take whatever steps necessary to obtain emergency medical care for my child. These steps may include, but are not limited to the following: a. Attempt to contact parent or guardian. b. Attempt to contact persons authorized on registration form. c. If the above is unsuccessful, the Center may do any or all of the following: 1. Call a physician or paramedic. 2. Call an ambulance and allow the child to be transported to nearest available hospital. 3. Have child taken to an emergency hospital in the company of a staff member. 4. All expenses incurred under part c will be borne by the child’s family. 5. The physician and/or medical facility are authorized to administer medical treatment necessary to assure the health and safety of my child. *
Required
I understand that missed classes/days will not be refunded, and late arrivals may mean the child misses important information or activties. *
Required
A $20 deposit will be required to hold your child's spot in each camp, but will be applied to your remaining balance. If the camp is cancelled for any reason, the full amount will be refunded.You may withdraw your child up to ten days before the start of the camp for a full refund. A refund will not be given after the ten day period, nor will it be applied towards a different camp. A minimum enrollment must be reached for each camp.
A copy of your responses will be emailed to the address you provided.
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