South Shore Stars 2015 Summer Camp and Fall Enrollment
|
|
- Christal Small
- 5 years ago
- Views:
Transcription
1 My child is in the grade, and attends After School Program. South Shore Stars 2015 Summer Camp and Fall Enrollment Child s Name(s) Parent s/guardian s Name Home Phone Work Phone Address Your child s school and grade in September, 2015 Please check and initial ALL that apply: I would like my child enrolled in Stars Summer Camp I would like my child to be enrolled in the Before School Program (FALL) I would like my child enrolled in the After School Program (FALL) My child will be leaving as of and will no longer need care. We will not refund for sessions chosen but not used. Exceptions will be made for medical reasons supported by physician s note. It is very important to check and initial ALL sessions that your child will attend. Session # 1: July 6 th -July 17th Session # 3 Aug 3 rd Aug 14 th Session # 2 July 20 th - July 31st Session # 4 Aug 17 th Aug 28 th Payments for sessions 1& 2 are due by 7/15. Payments for sessions 3 & 4 are due by 8/15 If your child is attending camp and you are requesting extended care hours, please choose from the following sites: (extended care 4:30-6:00 PM, 6:15 in Randolph) (Please check one) Quincy Atlantic Randolph St. Mary s Weymouth Please note that all previous balances must be paid in full before camp begins. Sessions, groups, extended care and transportation choices are available on a first come first serve basis. A one week non-refundable deposit is due with this agreement (to be applied to last week s camp fee) 1 st child: Total # of sessions chosen ( ) x $ per session = $ 2 nd child: Total # of sessions chosen ( ) x $ per session = $ * Please add $90.00 per session per child for transportation = $ *Please add $60.00 per session per child for After Camp ( If chosen) Total due = $ Amount Enclosed: MC/Visa # Check # Expiration Date: Parent s/guardian s Signature Date
2 South Shore Stars At Hale Reservation 2015 Health History, Emergency Contact, and Release Form 80 Carby Street, Westwood, MA Tel (781) Fax (781) Male Female Camper or Staff Name (First) (Last) (Middle) Birth Date (Circle One) Street City/Town State Zip Parent or Guardian Information Parent or Guardian Parent or Guardian Address (Only if different from address above) Address (Only if different from address above) Phone Work Phone Work Cell Phone Cell Phone Please list at least one emergency contact that, if necessary, could provide transportation home. Emergency Contact Address Emergency Contact Address Phone Work Phone Work Cell Phone Cell Phone Allergies Penicillin Seasonal Foods Insect Bites Other Drugs Other Please explain reaction and severity: Medications for above allergies: If medications will be administered at camp for above allergies a Medication Information Form must be completed Medications Will your child (or staff member) be bringing any medications (including over the counter medications) to camp? Yes (check one) No If Yes, please complete a Medication Information Form. Please check which of the following may be administered to your child if needed (administered by the Wellness Center): Tylenol Advil Benadryl Nasal Decongestant Cough Drops External Antibiotic Cream Anti-Itch Cream Sunscreen Antacid Insect Repellant with Deet Calamine Sudafed ALL of the above NONE of the above Immunization History: This Massachusetts is a two sided requires document. a Certificate Please complete of Immunization and sign for reverse side. all campers and staff. You may use the form provided or a copy from your doctor s office. Check if attached
3 Does your child (or staff member) have Asthma? Relevant Past Medical History, General Information, and Restrictions Will your child (or staff member) be taking an Inhaler or other medication to camp? Yes (check one) No If Yes a Medication Information Form must be completed Any physical, mental, or psychological conditions requiring medication, treatment, or restrictions while at camp? Does your child or (staff member) take any prescription or over-the-counter medication at home? List any past medical treatment or recent injuries: Describe any specific activities from which your child (or staff member) should be exempted: Any dietary modifications or restrictions? Physician Information: Name of family physician: Address of family physician: Phone: Date of last physical exam: Insurance Information: Insurance Carrier: Insurance Policy Holder Name: Policy of Group #: Authorizations: Accuracy of Information: This health history is correct so far as I know and the person herein described has permission to engage in all camp activities except as noted. Photo Release: I authorize Hale Reservation, American Camp Association, and South Shore Stars to have my child s (or staff members) photo to appear in camp brochures, videos, on websites or other promotional literature. Authorization for Treatment: In case of an emergency, I authorize Hale Reservation and South Shore Stars to administer first aid and to transport my child or (staff member) to the nearest hospital emergency room and to order X-rays; routine tests and treatment; and to release any records necessary for insurance purposes. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director, or his/her designee, to secure and administer treatment, including hospitalization, for the person named above. This form can be photocopied for camp trips. Acknowledgment of Risk and Waiver: I understand and acknowledge my camper (or staff member) may participate in a variety of activities including; swimming, boating, outdoor games, sports, rope course, and other rigorous physical activities. I hereby release and discharge, and agree to indemnify and hold harmless Hale Reservation and South Shore Stars and its officers, directors, members, agents, employees, volunteers, and any other persons or entities on its behalf, against all claims, demands, and causes of actions whatsoever, either in law or equity, relating to or arising from any participation, medical treatment, recommendation, transportation or administration, or any lack thereof. Signature of Parent/Guardian of Camper, Staff Member, or Parent/Guardian of Staff Member under 18 years of Age Date
4 Camper or Staff Name Birth Date 2015 South Shore Stars at Hale Reservation Camper Medication, EpiPen, and Inhaler Administration To be completed for any or all medications that will be brought to and administered at camp. Please Read: Prescribed medications must include the pharmacy label with the Rx number, the name of the medication, dosage, directions for use, and the child or staff s name. Non-prescription medications must be in its original containers, clearly labeled with the child s r staff s name and directions for use. All medications must be kept in the Health Center. Please completely complete the following information regarding the appropriate times and dosages of each medication your child or staff will receive at Hale (attach additional forms if needed). Please sign at the bottom of the page. Name of Medication (if Inhaler or EpiPen complete below as well): Why is this medication taken? Days Taken (please circle) M T W Th F As needed Times Taken (be specific) AM PM Other Dosage Are there any additional notes or instructions for this medication? Name of Medication (if Inhaler or EpiPen complete below as well): Why is this medication taken? Days Taken (please circle) M T W Th F As needed Times Taken (be specific) AM PM Other Dosage Are there any additional notes or instructions for this medication? Type of Inhaler: Location of Inhaler at camp (circle one) Health center or designated secure storage on campers person with camp counselor Who can administer inhaler? (circle one) Qualified Personal Camper Type of EpiPen : Location of EpiPen at camp (circle one) Health center or designated secure storage on campers person with camp counselor Who can administer EpiPen? (circle one) Qualified Personal Camper I hereby give permission for Hale Reservation to administer the following medications to my child or staff member under eighteen years of age during his or her camp attendance. Parent/Guardian Signature Date:
5 South Shore Day Camp 2015 Transportation Information These are TENTATIVE routes based on last year and this year s projections. Final routes will be sent in mid June. Changes may be 15 minutes per stop but you can switch to another stop on your route. After the first week of camp times should remain consistent. Bus monitors are instructed not to leave a stop until the designated time. It is our policy not to drop a child off at a stop without a parent to meet them unless we have written permission. If you would like to have your child left off alone at a stop please indicate on the attached form. Without written permission, we will not drop a child off unattended at his/her stop. We cannot have vehicles waiting at the stop for late parents. Your child will be driven to the nearest Stars Extended Care Location where staff will attempt to reach an emergency contact. Parents will be charged a late fee of $25.00 if this occurs. Buses leave camp at 4:00 PM. Drop-offs begin at approximately 4:30 and finish at approximately 5:30 PM. Drop-off times should remain consistent after the first week, depending on traffic problems.
6 South Shore Day Camp 2015 Transportation Child s Name: Bus Pick-up (AM): (select choices from next page) First Choice: Second Choice: Bus # Pick-up Time in AM Stop Name *You must have a second choice. Please be sure that it is a different Bus # than the first choice. Bus Drop-off (PM): (please check one) I will meet my child at his/her pick-up site. I will meet my child at a different location (same Bus#). I give permission for my child to walk home unattended from his/her pick-up site. I would like my child dropped off at the Extended Care Site chosen. (select below) Check if applicable: Quincy Atlantic Randolph St. Mary s Weymouth Extended Care Site (from 4:30-6:00pm in Weymouth and Quincy, 6:15 in Randolph) I give my permission for my child to be released from the program at the end of the day as described above, and/or to the following people. These people will also be contacted in an emergency, in the order listed, in the event parents or guardians can not be contacted. Name: Relationship: Address: Telephone #: Name: Relationship: Address: Telephone #: Name: Relationship: Address: Telephone #: Any other transportation or release requests must be stated in writing and maintained in the child s file. Your child will not be released to anyone not listed on this form without prior consent, preferably written. In the event that a parent can not be reached to confirm permission of an unauthorized person to pick up a child, staff may try to obtain permission from emergency contacts listed above. Parent s Signature Date
7 South Shore Day Camp TENTATIVE Transportation Routes (Based on last year's enrollment) FINAL TRANSPORTATION ROUTES WILL BE MAILED OUT IN JUNE. QUINCY BUS #1 QUINCY BUS #2 AM Pick-up PM Drop-off AM Pick-up PM Drop-off 7:30 Quincy High School 4;50 7:45 Parker School 4:55 7:45 Lincoln Hancock School 4:40 7:55 Bernazani School 4:40 Quincy Atlantic After Camp PM only 5;00 Quincy Atlantic After Camp PM only 5:00 Union Congregational Church Union Congregational Church 135 Rawson Rd. (617) Rawson Rd. (617) After Camp closes at 6:00pm After Camp closes at 6:00pm WEYMOUTH BUS #3 Weymouth BUS #4 AM Pick-up PM Drop-off AM Pick-up PM Drop-off 7:30 Abigail Adams 5:05 7:30 Seach 4:55 7:40 Pingree School 5:00 7:45 Weymouth High School 4:45 7:55 Joseph Fern Court/Lake Street 4:45 7:55 Nash School No PM Stop Weymouth After Camp PM only Weymouth After Camp PM only 200 Middle Street (781) : Middle Street (781) :05 After camp closes at 6:00pm After camp closes at 6:00pm RANDOLPH BUS #5 AM Pick-up PM Drop-off 7:30 Martin Young 5:05 7:40 Randolph High School 4:55 7:45 St Mary's School 4:50 St. Mary's After Camp 30 Seton Way :40 After Camp closes at 6:15pm 7:55 Donovan School 4:40 You can switch to another stop on your route. A phone call is not necessary but please tell the bus monitor. Please allow 10 minutes on either side of the pick-up and drop-off times for the first week of camp. The times should stay relatively consistent after that depending on traffic.
8 South Shore Day Camp 2015 Swim Form and Field Trips Dear Parents/Guardians: Annually, at no extra cost to you, South Shore Day Camp offers swimming and swim lessons. Our lessons are given by Red Cross Certified Instructors. Participation in our swim program is strongly encouraged. We have created incentives for campers who demonstrate improvement, move up swim levels, and pass the deep end test. Please discuss this option with your child as we will not force participation in this activity. Thank you, Camp Director Child s Name: Age: (please print) SWIM Please indicate below if you want your child to participate in the swim instruction: Yes I give permission for my child to participate in swim instruction No I do not give permission for my child to participate in swim instruction FIELD TRIPS Throughout the summer we provide a variety of field trips which may include going to: the zoo, museums, sporting events or roller skating. If you want your child to be able to participate in field trips, please indicate below: Yes I give permission for my child to go on field trips No I do not give permission for my child to go on field trips Parent s Signature: Date:
Registration Information and Fees
South Shore Day Camp 2015 Registration Information and Fees Parent Information Name: Address: Town: Zip: Home Phone: Work Phone: Cell Phone: Parent s Email address: Parent s Email address: Please circle
More information2018 Registration Packet
Registration Packet To Register: Complete all forms in the Registration Packet. A separate and complete Registration Packet must be submitted for each camper. Online registration is available at: www.halereservation.org/programs/hale-day-camp
More information2018 Medical Waiver and Release
2018 Medical Waiver and Release I hereby give my consent to the Summer Camps at Avon Old Farms School personnel to provide, through a medical staff of its choice, customary medical attention and emergency
More informationCAMP MCCUMBER. Overnight Camp. Camp Dates: Session I: July 8-July 14, 2018 Session II: July 29- August 4, 2018 Expedition Camp Theme
CAMP MCCUMBER Overnight Camp Going into 3rd -9th Grade Camp Dates: Session I: July 8-July 14, 2018 Session II: July 29- August 4, 2018 Expedition Camp Theme 2018 OVERNIGHT CAMP YMCA Camp McCumber Registration
More informationPage
Page 1 Page 2 Page 3 Page 4 WE ARE ACA ACCREDITED! (AND PROUD!) Page 5 Page 6 º º º º Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 º Page 18 Page 19 Page 20 Page
More informationGARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form
GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form REGISTRATION OPENS JANUARY 3, 2019 A FULL PAYMENT OF $25 PER CAMPER PER DAY MUST BE MAILED WITH THIS COMPLETED REGISTRATION
More information2018 Camp Aristotle Forms and Information
2018 Camp Aristotle Forms and Information Prior to starting camp, all families must complete the following. Please return this checklist along with the required forms. A supply list is included at the
More informationDear Camper and Family:
Dear Camper and Family: We are excited about this year s Growing Together Day Camp, Monday June 20 through Friday June 24 and hope that you will join us for a week of fun and adventure at Camp Tyler. CAMP
More informationCamp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History
First Name: _ Last Name: Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History Attending Camp Session(s) 1 2 3 4 5 6 7 8 LIT CIT Intern Staff The information on this form is not part
More informationRye Y Summer Camp 2018 Registration Checklist
Rye Y Summer Camp 2018 Registration Checklist Make sure you have completed all of these tasks to complete your camper s registration! Registration Completed in Full: o Make sure we have all possible authorized
More information2019 Registration Form
Please include a $50 NONREFUNDABLE DEPOSIT for each camp. Please complete a separate form for each camper. For Office Use Only Please Print Legibly Parent/Guardian Information Relationship to Camper Relationship
More informationCAMP MSC SENSATIONAL SUMMER SCIENCE
CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day
More informationCamper Health History form must be on file prior to arrival at NEMC
Dear NEMC Parent: Camper Health Form It is our privilege to care for your child while they are at camp. In order to do so safely and effectively, we ask that you use the checklist below to assure that
More informationCamp Hands Up 2018 Registration Form **Please Note: Prices are changed and see on the bottom**
Camp Hands Up 2018 Registration Form **Please Note: Prices are changed and see on the bottom** Participant Questions (Required) = * *First & Last Name *Date of Birth *Gender: Male or Female *Grade: *Email
More informationCamper Application. Legal Guardian #1 Information. Legal Guardian #2 Information: Family Status: Mailing Address: Address: City: State: Zip:
Camper Application Legal Guardian #1 Information First Name: Last Name: Relationship to Camper: Home Phone: Cell Phone: Work Phone: E-mail: Legal Guardian #2 Information: First Name: Last Name: Relationship
More informationSunday, August 12 Saturday, August 18, 2018 We welcome campers entering grades 3 ~ 12!
Sunday, August 12 Saturday, August 18, 2018 We welcome campers entering grades 3 ~ 12! We expect every space to be filled up, so get your application in early! Deadline Date: June 30, 2018 After June 30th,
More informationDay Camp Health Form and Waiver Packet
Day Camp Health Form and Waiver Packet Camper Name: Session Group: Date: Completion Checklist: Completed Health Form Signed Waivers Physical and Immunization Record Insurance Card Allergy, Asthma or Diabetes
More informationOvernight Camp 2018 Camper Information and Medical Form
Overnight Camp 2018 Camper Information and Medical Form Day camper medical form, other registration forms and/or online registration are available at www.circlerranch.ca This form must be submitted to
More informationCAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017
CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017 Registration Deadlines Return Campers: Aug 1st New Campers: September 11th (Please use only black or blue ink and complete all information) Camper
More informationMARYLAND 4-H CAMPS HEALTH FORM
MARYLAND 4-H CAMPS HEALTH FORM Camper s Name: _ Last First MI Nickname Current Photo Of Camper Male Female Age at Camp Arrival: Birthdate: Dates will attend Camp: to Street Address City State ZIP County
More informationCamp Zanika Required Camper Forms
Camp Zanika Required Camper Forms Every camper attending Camp Zanika must have a copy of the required forms. Forms can be found on our website, emailed, or mailed. All forms need to be returned to the
More informationBorough of Lincoln Park Parks & Recreation 2018 Summer Camp K-6 CAMP / SUMMER TOUR WAIVERS & MEDICAL FORMS
Borough of Lincoln Park Parks & Recreation 2018 Summer Camp K-6 CAMP / SUMMER TOUR WAIVERS & MEDICAL FORMS TO: FROM: RE: Parent, Guardian or Caregiver of a LP Summer Camper: Cathy Adubato, Camp Director
More informationHealth History & Emergency Form
Health History & Emergency Form - 2019 th THIS FORM IS DUE NO LATER THAN MAY 24. Camper s Last Name, First Male Female Birthdate / / rade Entering Fall 2019 Mother s/uardian #1's Last Name, First Father
More informationCamp St. Charles ANNUAL HEALTH FORM CHECKLIST
Camp St. Charles ANNUAL HEALTH FORM CHECKLIST Parents, please use this handy checklist to help you organize your child s health information and prepare everything that needs to be mailed to Camp. HEALTH
More informationPROGRAM INFORMATION: School s Out Activity Day 2012/2013 (ages: K-8 th ) January 21 February 18 March 25, 26, 27, 28 & 29 9:00am-6:00pm
PROGRAM INFORMATION: After School Rendezvous 2012/2013 (ages: K-8 th ) Winter Session (Winter Break-Spring Break)Monday-Friday, January 2-March 22 Spring Session (Spring Break-End of School) Monday-Friday,
More informationDates: 6/25-6/29 Monday - Friday (day camp 8:30am - 4:30pm)
Green Mountain Camp for Girls Registration Return by 6/1/18 (or until sessions fill) Payment options: Visit our website www.greenmountaincamp.com to pay entire fee with PayPal. Or, send a $100 non-refundable
More informationKIDDO CAMP PACKING LIST
KIDDO CAMP PACKING LIST WHAT TO PACK IN 22 GALLON (or smaller) Plastic tub with lid -- LABEL with your child's first and last name please!! WHAT TO BRING Sleeping bag, or twin sheets and cover Pillow and
More informationGARAYWA CAMP & CONFERENCE CENTER 2018 Summer Missions Camp Registration Form
GARAYWA CAMP & CONFERENCE CENTER 2018 Summer Missions Camp Registration Form A FULL PAYMENT OF $185 PER CAMPER MUST BE MAILED ON OR AFTER JANUARY 4th WITH THIS COMPLETED REGISTRATION FORM TO Garaywa Camp
More information2018 Application. Easy Online Enrollment: Application valid 1/16/18. New Jr. Camp Pricing!
FAMILY INFORMATION 2018 Application Easy Online Enrollment: WWW.SLDC.COM Application valid 1/16/18 New Jr. Camp Pricing! 30 YEARS S L D C Celebrating Our 30th Anniversary! Family Name Home Phone Address
More informationMARYLAND 4-H CAMPS HEALTH FORM
MARYLAND 4-H CAMPS HEALTH FORM Last First MI Nickname Current Photo Of Camper Male Female Home Address: Age at Camp Arrival: Birthdate: MM/DD/YYYY Dates will attend Camp: to MM/DD/YYYY MM/DD/YYYY Street
More informationFOR MORE INFORMATION:
CADILLAC AREA YMCA 9845 CAMPUS DRIVE CADILLAC, MI 49601 NONPROFIT ORGANIZATION U.S. POSTAGE PAID PERMIT NO. 63 CADILLAC, MI Early Bird Registration Register before April 1st SAVE $10 total fees For single
More information2018 Junior Lifeguard Camp Registration
Sign up for A power packed week of coaching in first aid, water safety, team building, CPR & rescue techniques for only $329.99. Sessions fill up quickly! Participant Name: DOB: Age: Grade in Fall 2018:
More informationDate Camper Name: LAST, FIRST (Please print) Medical Form
Date Camper Name: LAST, FIRST (Please print) Medical Form Medical information must be provided for you or your child to attend camp. To ensure the health and safety of our volunteer staff, adult and youth
More informationNetXtreme Intro Sheet
NETX YOUTH CAMP P.O. BOX 27 MAUD, TX 75567 For registrations after the deadline or other questions about registration call: 903.585.2569 fax: 903.585.9772 email: info@netxtreme.org www.netxtreme.org NetXtreme
More informationFOR MORE INFORMATION:
FOOTHILLS AREA YMCA FOOTHILLS AREA YMCA Offering 2 camp locations Seneca, SC & Walhalla, SC Early Registration: March 6 April 6, 2018 $40 per single camper $60 per family FOR MORE INFORMATION: Shannon
More informationCAMP (2267) Welcome to Banbury Kids Camp 2017!!! To register a camper for Banbury Kids Camp, you must include the following:
647-526-CAMP (2267) Welcome to Banbury Kids Camp 2017!!! To register a camper for Banbury Kids Camp, you must include the following: 1) The Camper Application Form (One per family) 2) Swim Form (One per
More informationCamper Authorization for Medical Treatment and Authorization to Pick-up Camper
Camper Authorization for Medical Treatment and Authorization to Pick-up Camper Please return all 5 forms at least week before your first day of camp to: Inside the Outdoors, 200 Kalmus Dr., Costa Mesa,
More informationSummer Art Camp 2015 Parent Orientation Guide
Summer Art Camp 2015 Parent Orientation Guide The following information is provided to answer most of the questions you may have as you prepare your camper to attend PAFA Art Camp. The leading counselor
More information2018 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM
2018 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM Instructions: Please return completed forms NO LATER than two weeks prior to the start of camp One set of forms per camper should be submitted per calendar
More informationBen Lomond Quaker Center Summer Youth Camps Box 686, Ben Lomond, CA (831) ENROLLMENT FORMS
ENROLLMENT FORMS THESE FORMS MUST BE COMPLETED AND POSTMARKED NO LATER THAN JULY 2ND OR FAXED TO 831-336-0218 EQUIRED EMERGENCY INFORMATION Please PRINT legibly Camper's Name Sex: M F Birth date: / / Social
More informationCALVERT COUNTY PARKS & RECREATION CALVERT COUNTY SHERIFFS OFFICE
CALVERT COUNTY PARKS & RECREATION together with CALVERT COUNTY SHERIFFS OFFICE Teamwork, Activities, Demonstrations, Swimming All squeezed into one week of Camp! Date: July 10 14, 2017 Time: 8:00 a.m.
More informationSUMMER AT THE YMCA 2019 Health History Form
SUMMER AT THE YMCA 2019 Health History Form This form must be filled out completely, signed by the camper s parent/guardian, and returned with requested documentation to the camp office or YMCA Branch
More informationWHY. Search Blue Mash Golf Camp on YouTube to view fun videos of the past years of Summer Camp!
WHY? The Areas Best Practice Facility- Blue Mash has the area s most immaculate and incredible practice facility featuring an all grass driving range tee. Your campers will receive instruction at our 10,000
More informationWashington County Recreation Department Robinwood Dr. Hagerstown, MD / CAMPER INFORMATION FORM
CAMPER FULL NAME CAMPSITE LOCATION HOME ADDRESS Washington County Recreation Department 11400 Robinwood Dr. Hagerstown, MD 21742 240-313-2805 / www.washco-md.net CAMPER INFORMATION FORM Do NOT return this
More informationCAMP SUNRISE LAKE 2019 REGISTRATION
CAMP SUNRISE LAKE 2019 REGISTRATION Photo: Please attach a 2x3 photo of the camper to this application. Camper Address Camper lives with: Both parents Mother Father Guardian(s) Home Address (Street): City,
More informationCamp Courage I May 17-19, 2019 Pre-Camp May 6, 2019 Camp Courage II October 4-6, 2019 Pre-Camp September 23, 2019
Dear Prospective Camper and Parent/Guardian: We are so pleased that you are considering Camp Courage as a way of supporting your child in dealing with the death of a significant person in their lives.
More informationCave Springs Camp Registration Form
Cave Springs Camp Registration Form Camper Information (please use one form per camper) Camper s Name: (Last) (First) Birthday: (D/M/Y) Age: Gender: Does your child require 1:1 support? Yes No (Please
More informationSOFTBALL Advanced Clinics Hitting, Pitching & Catching Camper Information Packet
SOFTBALL Advanced Clinics Hitting, Pitching & Catching Camper Information Packet Session Date Time Hitting Clinic Pitching/Catching Clinic Bonus: Hitting Mindset Friday, November 16, 2018 Friday, November
More informationOverview. Camper Confirmation Packet Easter Seals Washington Camp Stand By Me
Camper Confirmation Packet 2015 Email: campadmin@wa.easterseals.com Overview Welcome to the 2015 Season at Easter Seals Camp Stand by Me! This packet includes important paperwork that we need on file here
More informationCAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015
CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015 CAMPER INFORMATION Last First Middle Nickname _ Street Apt# City State Zip DOB Age Grade
More informationDAY CAMPS Camp Fee $10.00/session to be paid at time of application Day Camps Locations Leaders In Training Locations
Camper DAY CAMPS Camp Fee $10.00/session to be paid at time of application Day Camps Locations Leaders In Training Locations Dates Session 1 $10.00 July 9-20 Downtown (7-11 yrs.) Scarborough (6-8 yrs.)
More information2018 Summer Camp Packet
WOR LD CL A S S M A S T E R ' S C H O N G 2018 Summer Camp Packet for registered campers Lancaster Location IMPORTANT: The last 3 pages of this packet must be filled out and turned in no later than June.
More informationRESIDENTIAL CAMP PRESCRIPTION AND OVER THE COUNTER MEDICATION FORM
THE FOLLOWING MUST BE COMPLETED BY ALL PARENTS OF CHILDERN ATTENDING THIS CAMP AND SUBMITTED AT CHECK-IN If your child will be taking medication while at camp, it is state law to secure your consent for
More informationMUSIC CAMP REGISTRATION INSTRUCTIONS
REGISTRATION INSTRUCTIONS If you have any questions, please call us at: 203-925-9660 or 1-888-MYLESSON To Enroll: 1) Print and complete the attached forms. 2) Enclose a deposit check of $150 per camper
More information2018 Summer Camp Registration Please select which camp your child(ren) will be attending
1515 N. Galloway Avenue Mesquite, Texas 75150 972.216.6260 www.cityofmesquite.com 2018 Summer Camp Registration Please select which camp your child(ren) will be attending Kidz Kamp Sports Camp Camper Information
More informationFORM /GUARDIAN PLEASE HEALTH PARTICIPANT PROGRAM PARTICIPANT HEALTH FORM, CONT. TO BE COMPLETED BY PHYSICIAN ARENT/G CAMPER
GLOW YMCA CAMP HOUGH PARTICIPANT HEALTH FORM TO BE COMPLETED BY PARENT ARENT/G /GUARDIAN PLEASE TE THE NEED FOR PHYSICIAN HYSICIAN S S SIGNATURES ON BOTH SIDES OF THIS FORM ORM. T ALL YMCA SUMMER PROGRAMS
More information2017 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM
2017 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM Instructions: Please return completed forms NO LATER than two weeks prior the start of camp. One set of forms per camper should be submitted per calendar
More informationYMCA CAMP PINEWOOD 2014 Summer Camp Registration
YMCA CAMP PINEWOOD 2014 Summer Camp Registration Send completed form to 4230 Obenauf Road, Twin Lake, MI 49457 Fax to 231.821.0487 Email to mmccarthy@ymcachicago.org Call our office at 231.821.2421 with
More information2013 BFA Jr. Balloonist Hot Air Balloon Camp Camp Registration Form Reno, Nevada
2013 BFA High Sierra Balloon Camp Western States Region Balloon Federation of America Jeff Haliczer, Director 15225 Pinion Dr. Reno, Nevada 89521-8841 Home Phone: (775)853-4109 Camp E-mail: Renoballooncamp@sbcglobal.net
More informationAmerican Indian/Alaskan Native Black or African American Hispanic/Latino Asian or Pacific Islander Caucasian/White Mix Other
For Official Use Only: Branch: Camp Site: Camp Group: CHILD S FIRST & LAST NAME ADDRESS (Street Address, Apt#, City, Zip Code) DATE OF BIRTH (Month/Day/Year) CHILD S DISMISSAL [ ] BE PICKED UP [ ]WALK
More informationHomewood Parks & Recreation Homewood, Alabama Summer Day Camp 2019 Information Packet
Homewood Parks & Recreation Homewood, Alabama Summer Day Camp 2019 Information Packet INFORMATION PACKET Camp Dates, Hours & Fees Registration Fee: $100 Due at Registration (Per Camper) Day Camp Sessions
More informationDHAC School Vacation Camp
DHAC School Vacation Camp Required Camper Paperwork Please complete all forms and return prior to attending camp. Dedham Health & Athletic Complex 200 Providence Hwy Dedham, MA 02026 781-326-2900 www.dedhamhealth.com
More informationGIRLS LACROSSE Train Like a Tiger Clinic Camper Information Packet
GIRLS LACROSSE Train Like a Tiger Clinic Camper Information Packet Check-In Check-Out Date Saturday, December 8, 2018 Saturday, December 8, 2018 Time 9:00am 12:30pm Location Bubble at Princeton Stadium
More informationESO Summer Camp 2018
ESO Summer Camp 2018 Dear Parent/Guardian: We are so glad you are interested in attending ESO Summer Camp at the Barber National Institute. Attached is the 2018 ESO summer camp Application Packet. WE WILL
More informationEastman Area 4-H Summer Camp
Eastman Area 4-H Summer Camp It s not too soon to be thinking about summer camp! Eastman Area will once again be holding a summer camp for Junior and Intermediate members, from August 25 th -30 th at beautiful
More information$125 per student / per week
Located on the campus of The Foundation Academy Campus 3675 San Pablo Rd S., Jacksonville, FL 32224 6 weeks - June 17 July 26 8am ~ 5pm Extended Care is Available from 5pm ~ 6pm for an additional $10 fee
More informationPeterkin Camp and Conference Center
Camper Information Peterkin Camp and Conference Center A Ministry of the Episcopal Diocese of West Virginia Summer Camp Registration Please complete one form per camper per camp. Check which camp your
More informationCamper Information. New Garden Flying Field July 9-13 August 6-10
! 2018! Camper Information New Garden Flying Field July 9-13 August 6-10 www.newgardenflyingfield.com 2018 Future Aviators Summer Camp New Garden Flying Field, Toughkenamon PA. 610-268-2619 Camper Information
More informationCamper Application. DATE: Monday-Friday, June 18 - July 27 (Excluding July 4) 9 am - 12 noon. FREE! [Member] $20 [Non-Member]
Camper Application Greetings Parents & Campers! The Greater Elizabethtown Area Recreation & Community Services is proud to announce our Camp Ladybug 2018 theme: Exploring Nature!! Camp is for individuals
More informationCamp WAMP at Deer Lake CAMP APPLICATION 2018 SCHEDULE. Mail to: Shae Jewell 4848 Starflower Drive Martinez, CA
Camp WAMP at Deer Lake CAMP APPLICATION 2018 SCHEDULE Please check the session in which you wish to enroll. Mail to: Shae Jewell 4848 Starflower Drive Martinez, CA 94553 shae@wamplerfoundation.org CAMP
More informationThere will be no refunds.
Flint Park Day Camp Application- 2015 Camp Dates: July 6 th August 14 th In order for application to be accepted: 1. Application must be completed in its entirety. Immunization Records must be printed
More informationSIBLING/FRIEND APPLICATION 2013
SIBLING/FRIEND APPLICATION 2013 To be filled out by the parent/guardian of the friend/sibling. PERSONAL INFORMATION Name of Camper: Name of Primary Camper that he/she will be accompanying: Relationship
More informationUniversity of Miami 2007 Hurricane Aquatics Sports Camp Ages 5-12
University of Miami 2007 Hurricane Aquatics Sports Camp Ages 5-12 The University of Miami Head Diving Coach, Randy Ableman and Head Swimming Coach, Christie Shefchunas, both 4x All-Americans in their sport
More informationMidland Park Recreation SUMMER CAMP SIX WEEKS June 26- August 4, 2017
Midland Park Recreation SUMMER CAMP SIX WEEKS June 26- August 4, 2017 REGISTRATIONS WILL NOT BE ACCEPTED THE FIRST DAY OF CAMP, ALL CAMPERS MUST BE REGISTERED BEFORE THE START OF CAMP MAIL IN REGISTRATION
More information2018 Highfield Summer Camp Registration
2018 Highfield Summer Camp Registration Camper Name: Member Guest, member name: Parent/guardian name: Phone #: - - Address: City: State: Zip: Date of Birth: / / Grade Entering in Fall: Male Female Does
More informationSummer Camp Application Fax completed form to OR Print and mail to 4443 Grave Run Rd., Manchester, MD 21102
Summer Camp Application Fax completed form to 443-712-1015 OR Print and mail to 4443 Grave Run Rd., Manchester, MD 21102 _ Camper s Last Name First Name Middle Initial _ Grade Completed ( as of June) Birth
More informationMedical History Form
Medical History Form Childs Name: Age: Date of Birth: Weeks Attending: Gender: M F Parent/Guardian: Address: Home Phone #: Work Phone #: Cell Phone #: E-Mail: Emergency Contact Information: Name: Relationship
More informationOvernight Camp Registration
over ---> Summer 2019 Overnight Camp Registration Additional registration forms and/or online registration available at www.circlerranch.ca Camper Information: Male New Camper (Camper s last name) (Given
More information2015 Camper Health Form
2015 Camper Health Form Camp Frederick PO Box 258, 6996 Millrock Road, Rogers, OH 44455 Email: info@campfrederickohio.com Phone: 330-227-3633 FAX: 330-227-9005 Camp Frederick requires the following information
More informationSUMMER AT THE YMCA 2018 Health History Form
SUMMER AT THE YMCA 2018 Health History Form This form must be filled out completely, signed by the camper s parent/guardian, and returned with requested documentation to the camp office or YMCA Branch
More informationCAMP HORIZONS: WEST CABARRUS BRANCH
2018 SUMMER DAY CAMP REGISTRATION FORM CAMP HORIZONS: WEST CABARRUS BRANCH (Please Print) Today s Date: CAMPER INFORMATION Camper s Last First: Middle: Child s Code Word: Rising Grade (2018-19 School Year):
More informationCamper Registration Form 6/10/14
Camper Registration Form 6/10/14 Camper Name M or F Birthdate Mailing Address City State Zip Parent(s)/Guardian(s) Home Phone ( ) Cell Phone ( ) Work Phone ( ) Parent/Guardian Employer and Street Address
More informationCamp AB Summer Day Camp June 5, 2017 August 4, :00 am 5:00 pm Extended Day 7:00 am 6:00 pm
Abyssinia Baptist Church 10325 Interstate Center Drive Jacksonville, Florida 32218 Phone: 904-696-1770 Web: www.abyssinia.org email: ehopkins@abyssinia.org Camp AB Summer Day Camp June 5, 2017 August 4,
More information*MUST have independent bathroom skills.
Town of Crawford Summer Camp 2018 CAMPER REGISTRATION PACKET SUBMIT ONE PACKET PER CAMPER Five Weeks Camp Dates: Monday June 25 Friday July 27 CAMP IS CLOSED ON July 4 Camp runs weekdays: 9:00am-1:00pm
More informationDay and Resident Camp
Day and Resident Camp CAMPER NAME: BIRTHDAY: / / AGE AT CAMP: GENDER: M F ADDRESS: CITY: STATE: ZIP: PARENT/GUARDIAN S NAME: HOME/WORK/CELL PHONE: EMAIL: COUNTY: ETHNICITY: TRANSPORTATION/BUS SITES Car
More informationIMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS
IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS PLEASE NOTE OUR NEW LOCATION AT CAMP JOHN HOPE FFA-FCCLA CENTER IN FORT VALLEY, GA. 281 Hope Entrance Road, Fort Valley, GA 31030 Session One will be
More information2018 Day Camp Dates See you this summer!
DearKidsandParents, ItistimetogetreadyforCampRiseAbove!Weareexcitedtoinviteyouto our2018campsession,andhaveoutlinedbelowwhatourdayswillbe like.wehavealsoincludeda WhattoBring listonthebackofthispage. Ifyouwouldliketoattend,weaskyoutofilloutthe:
More informationStudent Camper s Name Age: Student Camper s Name Age: Student Camper s Name Age: Junior Counselor s Name Age: Junior Counselor s Name Age:
St. Rita School Summer Camp Program Registration Page 1 Please print out this form and complete it in its entirety. Return or mail this registration form AND all required medical forms to: ST. RITA SCHOOL
More informationDates Theme Field Trip Entertainment
Camp Kodiak Summer Day Camp - Outdoor Games - - Weekly Field Trips - - Fantastic Food Fridays - - Weekly Entertainers - Camp Kodiak Information Day Camp Hours: 9:00 a.m-3:00 p.m. Cost: $85.00 Extended
More informationCAMP TAWINGO 2018 CAMPER APPLICATION FORM SUMMER FUN FOR BOYS & GIRLS 7 TO 16 YEARS OF AGE
We have fun building GREAT kids! CAMP TAWINGO 2018 CAMPER APPLICATION FORM SUMMER FUN FOR BOYS & GIRLS 7 TO 16 YEARS OF AGE Please send this Application Form to: 1844 Ravenscliffe Rd Please check the session(s)
More informationROWING WINTER CLINICS Camper Information Packet
ROWING WINTER CLINICS Camper Information Packet Day 1 Day 2 Session 1 Saturday, January 5, 2019 (12pm 5pm) Sunday, January 6, 2019 (10am 3pm) Session 2 Saturday, January 19, 2019 (12pm 5pm) Sunday, January
More information2019 CAMP WARWICK R EGISTRATION FORM
2019 CAMP WARWICK R EGISTRATION FORM THIS FORM MUST BE COMPLETED BY PARENT/ GUARDIAN AND SUBMITTED WITH PAYMENT AND OTHER REQUIRED DOCUMENTS BEFORE REGISTRATION WILL BE ACCEPTED. THE PERSON REGISTERING
More informationSummer Camp at Wesley Gardens 2016 Registration
Summer Camp at Wesley Gardens 2016 Registration Camper Information (Please use a separate form for each camper) Camper s Name Goes by Camper s Age Grade Fall 2015 Male/Female Home Address City/State Zip
More informationClark's Self Defense Karate Adventure Summer Camp
Clark's Self Defense Karate Adventure Summer Camp Our Summer Karate Camp is one of the most unique summer camps available to children. It provides an enriching selection of self defense activities as well
More information2017 Camp Requirements. Why does Mercy Street go to camp?
Summer Camp 2017 August 6-11 Once again, Mercy Street is blessed beyond measure in our partnership with Pine Cove Christian Camps! We are excited to be going to Pine Cove Outback located in Columbus, Texas
More informationResidential campers will report Sunday evening, and parents need to pickup Friday afternoon
Thank you for registering your child to attend our fun-filled summer camps. Our camps are packed with many opportunities to learn, make friends with other Deaf or Hard of Hearing kids, and explore outlets
More information2017 Critter Camp Humane Society of Carroll County
Humane Society of Carroll County Dear Parent/Guardian: We are excited to have your camper join us for Critter Camp at the Humane Society of Carroll County this summer? Our goal is for children to develop
More informationTO COMPLETE YOUR CHILD S APPLICATION FOR SUMMER 2016:
Please be sure you have completed the online application before submitting these forms. TO COMPLETE YOUR CHILD S APPLICATION FOR SUMMER 2016: 1. Please read the Camp Pembroke Policies. 2. Read, complete,
More informationSummer Camp Registration Form
OFFICE 817.573.3343 METRO 817.578.3181 FAX 817.573.3441 www.campcrucis.org Summer Camp Registration Form Please submit a separate application for each camper or camp session. Please print or type. Session
More informationComplete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280
Complete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280 REYOAD and Camp 139 Registration Form - 2018 Camp REYOAD
More information