/ Cary Academy Summer Quest
Registration Form
Cary Academy Summer Quest is now accepting online registration.
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If you register online you do not need to fill out this form.

Section 1: Camper’s Information

Camper’s Name: ______(First) (Last) (Nickname)

Street Address: ______

City: ______State: ______Zip: ______Home # (____)______

Birth Date: (M/D/YEAR) ____/____/______Age_____  Male  Female

Grade Entering in Fall ‘14: ______Present School ______Preferred Email ______

T-shirt Size:(100% cotton) Youth: YM (10-12) YL (14-16) Adult: AS AM AL AXL AXXL

How did you hear about Summer Quest programs? ______

Throughout the year, we e-mail parents about additional program offerings that are open to the public. If you are not a CA family, would you like to receive these program announcements?  Yes  No (If no box is selected, you will automatically be added to the list.)

Section 2: Family Information

Mother/Guardian’s Name: ______Employer ______

Home Address: ______City: ______State: _____ Zip ______

Home # (___)______Work # (___)______Cell or Pager # (Circle) (___)______

Father/Guardian’s Name: ______Employer ______

Home Address: ______City: ______State: _____ Zip ______

Home # (___)______Work # (___)______Cell or Pager # (Circle) (___)______

With whom does the Camper reside? Both Mother Father Guardian

Section 3: Release Authorization

This person(s) may be required to show proper Identification and must have a release form with parent signature for child to be released to that individual.

Name: ______Relationship: ______

Name: ______Relationship: ______

Name: ______Relationship: ______

Section 4: Emergency Care Information

If neither parent nor guardian can be contacted, call:

Name: ______Relationship:

Work# (___)______Home#(___)______Cell # (__)______

Name: ______Relationship:

Work# (___)______Home#(___)______Cell # (___)______

Section 5: Health Information

Cary Academy Summer Quest welcomes the participation of all individuals in our programs. We are fullycommitted to complying with the ADAA standards providing reasonable accommodations to facilitate participation in our programs. To ensure that adequate resourcesare in place, information regarding medical needs should be completed during the registration and should be received at least two weeks prior to the start date of the program. We recommend that parents or guardians consult their camper’s pediatrician or health care professional to assess their ability to participate in the program. It is requested that parents or guardians provide in writing any additional instructions for the specific condition or special needsof their camper and send to . Without disclosure, Cary Academy Summer Quest may not be able to accommodate and camper may be removed from his/her current or future camps without a refund.

Check all that apply: /  Headaches/Migraines /  Seizures/ Epilepsy /  Hearing Loss
 ADD  On medication /  Concussion or Head Injury /  Diabetes Type ______ Insulin /  Vision Loss
 ADHD  On medication /  Major Surgery or Illness /  AllergiesEpi Pen (carries) /  Eyeglasses/contacts
 Emotional Problems /  Heat Stroke/ Exhaustion / ___ Medications___ Food /  Sprains, Fractures, Dislocations
 Behavior Problems /  Asthma  Inhaler (carries) / ___ Insects___ Plants / Date of Last tetanus shot ____
 Heart Disease/Defect /  Contagious Disease /  Immunizations are up to date /  Other

Please give a detailed explanation for anything checked above and list of medications with dosage:

Section 6: REGISTRATION

Code (see descriptions) / Program Name / Fee
Extended Care Total (see selections below)
TOTAL FEES DUE

BEFORE AND AFTER CAMP CARE - Before, Lunch and After Care is offered for campers who are in rising grades2 - 12.

Cary Academy offers an extended care option to meet the needs of today’s working families. Extended care activities may include opportunities to play board games, read books or participate in arts and crafts and recreational activities in a supervised environment. The central location for drop-off and pick-up is in the Sports and Education Annex (SEA building). A healthy snack will be provided in the aftercare program.

LUNCH CARE

Lunch care is available for any camper who is registered for both a morning and afternoon camp or a full day camp Alternatively, a parent is able to pick up his/her child for the lunch break. Please indicate below whether your child will be attending lunch care each week. Lunch care is not available for campers attending only one half-day camp.

Campers who attend lunch care should bring lunch and beverage with a cooler pack. No refrigeration is available. Vending machines and a concession area are available and stocked with juices, soft drinks and a variety of healthy snacks. Dining facilities will be open and supervised during lunch care.

Dates / Before Care
8am - 9am / Lunch Care
Noon - 1pm / After Care
4pm - 6pm /

Weekly Fee

June 16 – June 20 / $30 / Free / $50
June 23 - June 27 / $30 / Free / $50
July 7- July 11 / $30 / Free / $50
July 14- July 18 / $30 / Free / $50
July 21- July 25 / $30 / Free / $50
Enter Extended Care Total in above worksheet:

Section 7: Permissions and Waivers

Field Trip Permission

As the undersigned parent or guardian, I grant permission for my child to leave the Cary Academy premises on authorized trips under the supervision of Cary Academy Summer Queststaff.

Release & Indemnity Agreement

I understand that participating in the Summer Quest program involves risk. These risks include, but are not limited to, inclement weather, facility or equipment problems or failures, contacts with and actions of other participants, and physical injuries, among others. I choose for my child and myself to participate in the program despite the risks. By signing this form, I acknowledge all risks of injury, illness, and death and affirm that I have assumed all responsibility of injury, illness, or death in any way connected with participation in the program. I certify that there are no medical or other reasons why my child should not participate in this program. I also agree for myself and for any child participant to follow all rules and procedures of the program and to follow the reasonable instructions of the teachers, supervisors, and staff of the program. In return for the opportunity to participate in this program, I agree for myself and for me heirs, assigns, executors, and administrators to release, waive and discharge any legal rights I may have to seek payment or relief of any kind from Cary Academy, its employees or its agents for injury, illness, or death resulting from this program. If I am registering a child for a program, I agree that I am a parent, legal guardian, or am otherwise responsible for the child whose application I am submitting and that I release waive, and discharge any legal rights that I may assert on behalf of the child participation in the program. I also agree not to sue Cary Academy, its employees,or its agents and agree to indemnify Cary Academy for all claims, damages, losses, or expenses, including attorney’s fees, if a suit is filed concerning an injury, illness, or death to me or to my child resulting from participation in the program.

I, the undersigned parent or guardian, understand that an emergency situation may arise where the delay of medical or surgical procedures could endanger the well-being of my child. I do hereby grant permission to the staff of Cary Academy Summer Quest to render judgment in my absence concerning medical assistance or hospital care in the event of an accident or illness. I understandthat Cary Academy will not administer any medications to my child unless a medication release form has been provided.

I HAVE READ ALL INFORMATION ON THIS REGISTRATION FORM AND AGREE, ON BEHALF OF MY CHILD AND MYSELF, THAT I UNDERSTAND AND WILL ABIDE BY ALL POLICIES AND PROCEDURES. I AGREE TO INFORM MY CHILD OF ALL BEHAVIOR EXPECTATIONS WHILE ATTENDING THE CARY ACADEMY SUMMER QUEST PROGRAM. I also acknowledge that all information is correct and my child is physically and emotionally capable of positivEly participating in specified PROGRAM activities. BY SIGNING BELOW, I ALSO GRANT CONSENT TO ALL PERMISSIONS AND AGREE TO ALL WAIVERS ON THIS REGISTRATION FORM AS NOTED.

Print Name: Signed: Date:

SECTION 8: Guidelines & Procedures

Summer Program Guidelines

  1. Campers are expected to abide by the behavior expectations; parents/guardians must review the guidelines with their child prior to the start of camp.
  2. Except when excused by the Summer Quest Director, all campers are expected to remain on campus with the camp in which they are enrolled.
  3. All campers should come dressed in appropriate attire for the type of camp he/she is attending. Specifically, campers participating in sports camps should dress appropriately and bring proper equipment. Specific information will be provided before the start of camp.
  4. Cary Academy is a tobacco-free campus and as such prohibits the use of and distribution of all tobacco products by everyone on campus.
  5. Cary Academy is a pet-free campus with the exception of service dogs and those used as part of a camp’s instruction.
  6. Campers are not permitted to possess or use alcoholic beverages or illegal substances on or off school property. The possession of weapons or explosives of any kind, or objects, toolsor devices that may be used as weapons is prohibited on campus and at any summer program related activity.
  7. During the registration process and no less than two weeks prior to the start of camp, any special physical, emotional, psychological, or medication needs of your child must be identified and if necessary discussed with the Summer Quest Director to ensure we are able to make reasonable accomodations.

Camper Behavior Expectations

One of the primary objectives of the Summer Quest staff is to provide a positive and safe environmentthat allows your child to have a fun and enriching camp experience. In order to provide such an experience, Summer Quest asks that all staff members use praise and positive reinforcement as an effective way of managing the behavior of each camper.

Should a negative behavior issue arise, we will apply the following guidelines:

  • First occurrence:A quiet, verbal reprimand
  • Second occurrence:Verbal warning to camper and a phone call to parent or guardian
  • Third occurrence: Written incident report will be given to the parent or guardian.
  • If the inappropriate behavior continues beyond the written warning, the camper will be asked to leave for the remainder of the camp with no refund of already collected fees for that camp. In addition, the camper will not be permitted to attend future camps for which he/she is registered; refunds will be made in accordance with the Summer Quest refund policy.
  • If the offense is severe, including, but not limited to: fighting, theft, vandalism, possession of weapons, alcohol, cigarettes, or illegal substances, inappropriate language, severe verbal threats, physical aggression, leaving the designated area without permission, sexual misconduct or other behavior that significantly disrupts camp activities or creates an unsafe environment for the camper or others, the camper will be IMMEDIATELY dismissed from the current camp and any other camp he or she is registered to attend, bypassing all steps above, and no refundwill be given.The actions taken will be at the discretion of the Auxiliary Programs Director.
  • There will be no refunds if cancellation takes place after the program starts or if a camper is temporarily or permanently suspended from a program due to failure to follow program guidelines (see above).

Payment and Registration Forms

All payments for camp registrations must be made in full at the time of registration. Payment may be made by credit card, check, or cashier’s check/money order.

  • In order to pay by credit card, you must register using our online registration tool at .

In order to pay be check or cashier’s check/money order, you must complete a paper registration form. Make checks payable to Cary Academy. The registration form and payment can be mailed to: Cary Academy Summer Quest, 1500 North Harrison Avenue, Cary, NC 27513 or hand delivered to the receptionist at Cary Academy located in the Administration Building.

Upon receipt offull payment, a Summer Quest confirmation will be sent to you. If you are registering online, please do not send in a duplicate copy of the registration form. Camp registration will be accepted until4 p.m. on the Wednesday prior tothe start date of each camp.

TRANSFER Policy

All transfer requests must be submitted in writing and may be sent to the Summer Quest office via e-mail .

After April 1, 2014, a transfer fee of $15 per camp will be charged to the customer.

Refund Policy

All refund requests must be submitted in writing and may be sent to the Summer Quest office via e-mail .

All summer programs require a minimum enrollment; you will be notified at least two weeks prior to the start date in the event a program must be cancelled. Program fees are fully refundable when the program is cancelled by Cary Academy. Otherwise, program fees are refundable as follows:

  • Cancellations received in writing on or before April 1, 2015 will be entitled to a full refund less a $25 cancellation fee per program.
  • Cancellations received after April 1, 2014 will only be entitled to a refund (less the applicable cancellation fee per program) if the camper’s spot can be filled.

DISCOUNTS

The Early Bird discount is non-transferable.