SUMERCAMP______SPRING BREAK_____
PERSONAL INFORMATION: Participant
Name: ______
Age: ______DOB: ______Sex: M ______F______
Address: ______
______
PARENTS
Father's Name: ______.E-mail: ______
Phones: H.:______O: ______. Cell: ______
Mother's Name: ______.E-mail: ______Phones: H.:______O: ______. Cell: ______
ADDITIONAL INFORMATION:
Week (s) in which child will participate: (mark with an "X")
June 12 to 16 July 24 to 28
June 19 to 23 July 31 to August 04
June 26 to 30 August 07to 11
July 03 to 07 August 14 to 18
July10to 14
July 17 to 21
Do you authorize your child to do activities in the pool? : Yes___ No___
Can your child swim: Good___ Somehow____Not at all___.
PERSON (S) AUTHORIZE TO PICK UP YOUR KID: (First and Last name)
1.______2.______
3.______4.______
(No child will leave with an adult unless he/she is in this form)
GENERAL CONDITIONS
1.We will not be responsible for any objects or personal belongings that the camp has not authorize to bring. (iPod, cell phones, CD, Computerized games, sport equipment, toys in general, etc.). The loss or damage of these unauthorized objects will not be our responsibility under any circumstance.
2.All of the accessories that you consider necessary for your kid's well-being will need to be expressed in writing to the camp manager, but we will not be responsible if lost, damage or stolen.
3.It is strictly mandatory that each camper bring his/her clothing identified with his/her name. The name should be written inside of the clothing.
4.Parents or representatives can observe the activities that the kids perform, so long as they do not interfere with the development of such activities.
5.Parents or representative will be prohibited surpass the limits of security that are set by the camp administration in the areas such as cafeteria, fields, special activities, pool, etc.
6.Once camp has started parents or representative will not be reimbursed for the payment of the week(s) that they have enrolled under any circumstance. (This includes sickness, suspension for bad behavior, problems with coping with other kids or any other reason)
7.Parents or representative need to inform the camp manager in writing any medication taken by the camper, his/her medical history, allergies, and any other information that they consider absolutely necessary and indispensable in case of an emergency.
8.The parents or representative will accept any other expense rose, from any sickness or accident that is not cover under our insurance policy.
9.The parents or representative agree that the admission and permanent stay of the campers is subject to the conditions that he/she meets the norms, rules and regulations of the camp.
10.The camp will be responsible for the kid from 8:00am to 5:00pm. There will be a $10 fee if the kid is pick up after 5:00pm, passed by every 15 min.
11.The camper will not be allowed to go to the field trips if he or she does not bring the camp uniform. This policy is strictly enforced for security reasons.
I,______legal representative of ______agree to all the rules and regulations set forth in this form and based on this rules and regulations I am registering my kid understanding that I will not be allow to dispute any of these rules set by the Administration. Said disputes will not have any support nor will be taken into consideration as I have read and understood the rules set forth before signing this document.
Legal Representative: ______
Father: ______
Mother: ______
Important Note: The registration will not be effective until this form is properly sign by the mother, father or legal representative without any exceptions.
MEDICAL HISTORY
NOTE: Please provide with any and all information needed to properly register your kid (s).
Name of camper:______
Age (Years and Months): ______
Does he or she have any physical impediment: ______
Asthma: Yes:___ No:____
Is your kid allergic to any medications or food? : ______
Does your kid take any medication? ______
Amount of dose ______
Name of the kid's Doctor: ______
Phones: Office: ______Cell: ______
Place of work: ______
Place where you will want your kid in case of an emergency:
______
Any other information you may consider necessary
______
______
______
Representative ______
Father: ______
Mother: ______