The

IDEAL Camp

The

I. D. E. A. L.
Camp

Campers Name: Date of Birth: Home Address:

REGISTRATION FORM
Gender: Age: Home Phone:

City, State, Zip Code: Cell Phone:

1. Parent/Guardian: Email Address: 2. Parent/Guardian: Cell Phone: Email Address:

Relation to Child:

Work Phone:

Home Phone:

Relation to Child:

Work Phone:

Home Phone:

All balances must be paid in full within 7 camp days of receipt. NO REFUNDS will be given. Please read carefully and sign the following Registration-Understanding Waiver
In consideration for being allowed to participate in any way at The IDEAL Camp Summer Program and related events, I, the undersigned voluntarily agree to assume full and complete responsibility for any injury or accident which may occur to the above named child during or in connection with The IDEAL Camp or its staff while they/I am on the premises of The IDEAL Camp. I acknowledge that at The IDEAL Camp they/I will participate in activities that may involve, among other things, physical contact with persons or objects, including the ground, and may incur a risk of injury. I specifically waive, give up and release The IDEAL Camp and its staff from all liability for any claim for damages which the above named child/I may have relating to injuries or illness that they/I may sustain. In signing this waiver, I certify that the above child/I is/am in good health, with no chronic illness or abnormal tendencies. In the event of an emergency in which the above named child/I requires medical care, I authorize The IDEAL Camp to act for me and obtain whatever medical, surgical or dental examination, diagnosis and/or treatment is deemed necessary. The IDEAL Camp is not responsible for the above named childs/my personal belongings, which may be lost, stolen or damaged. I further understand that I should be aware of the above named childs/my physical limitations and agree not to exceed them. I agree to review the rules and inspect the facilities and if I believe it is unsafe, I will advise his/her counselor and refuse to participate. I UNDERSTAND The IDEAL Camp WAIVER POLICY.

Signature: Credit Card must be kept on file Card Number:

Printed Name:

____ Visa ____ MasterCard ____ Discover ____ American Express Expiration Date: Signature on Card: Charge My Credit Card for Billing ____

I understand The IDEAL Camp payment policy. I authorize The IDEAL Camp to charge my credit card for additional fees and/or outstanding balances. Signature: Printed Name:

The IDEAL Camp

The

I. D. E. A. L.
Camp

TUITION AGREEMENT

I understand the full payment of tuition is due and no changes or substitutions in schedule can be made regardless of the following circumstances: If my child is absent due to illness My child is absent due to vacation A holiday falls on my child's scheduled day Delayed openings/early closings due to unforeseen weather conditions or circumstances beyond our control. 5. My child is absent due to any other reason 1. 2. 3. 4.

CAMP POLICIES: NO REFUNDS Payments will be made up front or in bi-weekly installments for the duration of the 10 Week Camp All accounts must be paid in full prior to the final week of camp All payment is due whether your child attends camp for the number of allotted days on the purchased plan or not Prices may include additional fees based on method of payment or tax (depending on the state) $40 returned check fee $200 of the total purchasing price agreed to is due up front the remaining balance must be paid in full upon the terms of the receipt 1 Week packs must be paid in full upon purchase At the time of registration, you must pay the required deposit per camper and a $50 registration fee per camper (not to exceed $100 registration fee per family) Any schedule changes must be made at least 1 week in advance in writing Any unpaid balance 7 camp days past the receipt date will be considered late and will be subject to a $20 late fee will be added to the upcoming payment, or will be charged to the credit card on file Sign-in/Sign-out instructions will be given to you prior to the start of camp All billing invoices will be paper statements Any billing questions should be directed to the accounting department at 732-233-1846 BEFORE-CARE/AFTER-CARE POLICY Camp starts at 9 AM If you arrive early, you can make use of our before-care services, otherwise you must remain with your child until 9 AM Camp ends at 4 PM If your child is not picked up at 4 PM, he will be placed into our after-care program If your child is dropped off before 9 AM or picked up after 4 PM, your account will automatically be billed for the before-care/after-care fees You will be charged for the full hour regardless of drop-off/pick-up time Your child MUST be picked up by 5 PM If your child is not picked up by 5 PM, you will be charged $25 per child per hour Any repeat offenders of late pick-up will be subject to additional fees or expulsion from camp By signing below, I acknowledge my responsibility to meet all of the Tuition Agreement terms and payment requirements for the duration of the package. I also acknowledge that this Tuition Agreement carries over and applies to each additionally purchased package. I understand The IDEAL Camp payment policy. I authorize The IDEAL Camp to charge my credit card for any additional fees and/or outstanding balances. Signature: Printed Name:

The IDEAL Camp

Campers Full Name: Packages & Pricing

The

I. D. E. A. L.
Camp

SCHEDULE FORM
Date of Birth:

Initial Purchase must include AT LEAST Two Weeks Before-Care/After-Care Rate: $10 per hour

Package Weekly Daily

1 5 Weeks $200 $40

6 10 Weeks $175 $45

Purchased
(Write in Number of Weeks under Appropriate Column)

2013 Camp Schedule

Camp Hours 9:00 AM 4:00 PM Before-Camp Hours 8:00 AM 9:00 AM After-Camp Hours 4:00 PM 5:00 PM Please check each box for ALL camp days your child will attend. Circle Before-Care(BC) and/or After-Care(AC)

Week # 1 2 3 4 5 6 7 8 9 10

Dates 5/27 5/31 6/3 6/7 6/10 6/14 6/17 6/21 6/24 6/28 7/1 7/5 7/8 7/12 7/15 7/19 7/22 7/26 7/29 8/2

MON BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC

TUES BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC

WED BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC

THURS BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC BC AC

FRI

Registration Fee: $50 per child. $100 maximum per family Required Deposit: $200 per camper Late Fee: All bills need to be paid in full upon receipt. If payment is not received within 7 camp days of billing, a $20 late fee will be applied to the account & the credit card will be charged for the full balance. Change of Schedule: Any schedule changes must be made at least 1 week in advance in writing NO REFUNDS

Amount AC/BC BC $ AC BC $ AC BC $ AC BC $ AC BC $ AC BC $ AC BC $ AC BC $ AC BC $ AC BC $ AC

Total AC/BC Cost: Final Total: Registration Fee: Deposit: Balance:

The IDEAL Camp

The

I. D. E. A. L.
Camp

EMERGENCY CONTACT & AUTHORIZED PICK-UP

I authorize the following people to pick up my child from The IDEAL Camp. In the event that an individual who does not appear on the authorized pick-up list will pick up my child, a written notification MUST be presented PRIOR to the start of camp by the parent/guardian. In such, this written request absolves The IDEAL Camp from responsibility after the child leaves the camp. All written requests will remain on file at camp. The IDEAL Camp has the right to verify identification with photo ID, such as a drivers license or passport. Parent/Guardian Signature: Date:

1. Contact Name: Address:

Emergency Contact/Pick-ups Must be 18 Years or Older

Relationship to Child:

Phone: Home Cell Work 2. Contact Name: Address:

Circle YES or NO Emergency Contact YES NO Authorized Pick-Up YES NO Relationship to Child:

Phone: Home Cell Work 3. Contact Name: Address:

Circle YES or NO Emergency Contact YES NO Authorized Pick-Up YES NO Relationship to Child:

Phone: Home Cell Work 4. Contact Name: Address:

Circle YES or NO Emergency Contact YES NO Authorized Pick-Up YES NO Relationship to Child:

Phone: Home Cell Work

Circle YES or NO Emergency Contact YES NO Authorized Pick-Up YES NO

The IDEAL Camp

The

I. D. E. A. L.
Camp

HEALTH RELEASE FORM

The IDEAL Camp

The

I. D. E. A. L.
Camp

AUTHORIZATION FOR EMERGENCY TREATMENT

Campers Information:
Campers Name: Street Address: Phone: Social Security #: City, State, Zip Code: Date of Birth: Age: Gender:

Medical Information:
State any medical problems (if none leave blank): Allergies to medicine, food, insects, animals etc.: List any and all medications your child is taking:

Physician/Insurance Information:
Physicians Name: Address: Insurance Carrier: Address: ID #:

Phone:

Policy #:

Phone: Group #:

Additional Information (use back if necessary):

By signing below, I state that I, the parent/guardian, have legal custody of the above child and attest that the information above is correct. I authorize The IDEAL Camp Director or Directors designee to obtain emergency treatment for my child. I consent to an x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to the minor at a recognized medical facility, under the general or special supervision of a licensed physician or surgeon. THE FOLLOWING STEPS WILL BE FOLLOWED IN AN EMERGENCY: 1. The Parent/Guardian will be contacted immediately 2. The childs physician will be contacted 3. We will attempt to contact you through all emergency persons listed on the childs application form 4. If we cannot contact you or your childs physician, we will do any of the following: a) Call for emergency first aid b) Call another physician c) Have the child transported to an emergency hospital in the company of a staff member

Signature:

Date:

The IDEAL Camp

The

I. D. E. A. L.
Camp

EXPULSION POLICY
Unfortunately, there are situations in which we have to expel a child from our program, either on a short-term or permanent basis. We will do everything possible to work with the family of the child in order to prevent this policy from being enforced. The following are reasons we may have to suspend or terminate a child from our program: 1. Parental Actions for a Childs Expulsion Failure to pay and/or habitual lateness in payments Failure to complete required forms including immunization records Physical and/or verbal abuse of staff or campers 2. Childs Actions for Expulsion Poor medical conditions Conduct detrimental to themselves or fellow campers and staff Behavior or influence deemed unsatisfactory The IDEAL Camp reserves the right to expel a child at any point. No refunds will be issued in the event of expulsion. Name of Child: Parent/Guardian Signature: Date:

The IDEAL Camp

The

I. D. E. A. L.
Camp

PHOTOGRAPHY CONSENT
This form gives The IDEAL Camp permission to photograph my child for the sole purposes of: Use on The IDEAL Camp Website Insertion in camp photography projects Camp Brochures News Releases Print & Digital Media Advertisement I understand that this is the policy of The IDEAL Camp, that unless expressly permitted by a parent at the time a photograph is used or printed that the names of the children will never be associated with their photograph. Name of Child: Parent/Guardian Signature: Date: