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2017 Summer Camp

2015 Camp Registration


Registration Form
Form

2017 Summer Camp Registration Form


2017 Form
AllAllforms
forms are
can to
be be returned
found online: on or before July 4th
http://go.dtcc.edu/swCamps
Registration fee of $30 required on submission of this form
Office Use Only: Identification Number Age: Gender:

Campers Name: (Last) (First) Class/Form: Birth Date: (Required)

Street Address: School Attending 2016-2017:

parent/Guardian email (used to confirm registration)

parent/Guardian Work-Company Name: Are there custody arrangements we should know about?
q Yes q No
1st Parent/Guardian Name: 2nd Parent/Guardian Name:

Home phone #: Home phone #:

Work phone #: Work phone #:

Cell phone #: Cell phone #:

Emergency Contact:
(Please provide the name of someone NOT listed above - parents/guardians listed above will always be contacted first)
Name: Relationship: phone #:

Parent Guardian Consent:


The following individuals are authorized to pick up my child at the end of the camp day:
Name: Relationship: phone #:

Name: Relationship: phone #:

Name: Relationship: phone #:

Health Related Information:


Allergies: physicians Name: phone #:

How
How did
did you
you hear
hear about
about our
ourcamp?
camp?
Opt-in
Opt-in to
to receive
receive information
informationabout
aboutcamps
campsvia
viae-mail
e-mailby
bychecking
checkingthe
thebox
box q.
q.
please
Please Note:
Note: All
All sections
sections of
of this
thisregistration
registrationform
formmust
mustbebecompleted
completedinintheir entirety.Incomplete
its entirety. Incompleteinformation
informationcancanresult
resultinin
delays
delays in
in processing
processing your
your childs
childscamp
campregistration.
registration.please
Pleasetake
takeaamoment
momentto tomake
makesuresurethat
thatall
allinformation
informationisisaccurate.
accurate.
2017
2015 Summer
Summer Camp
CampRegistration
RegistrationForm
Form

Summer Camp T-Shirts are here!


For only
Order $7tshirts
your a t-shirt,
nowyou can $30
for only wear a new one every day. Get one for
Mom,supplies
while Dad and all your siblings. Child sizes available in small, medium
last.
and large. Adult sizes available in small, medium, large and extra large.

Camp t-shirt Select size(s):


Children q S q M q L
Adult size(s): q S q M q L q XL

Please indicateofsize
Total number when registering
t-shirts x $7 =
If registering on-site, please indicate
(Repeat this amount on line 6 below)
size on reservation form.

14
Summer Camp Authorization Form

Campers Name:
2015
2017 Summer
Summer
Due to Camp Registration
Camppublic
state of Delaware Registration Form
Form we are obligated to have on file current immunization records for all campers
Health requirements,
attending our camp. You must provide a photocopy of your childs immunization record that indicates they are up to date on the
following immunizations:
Summer Camp Authorization Form
Diphtheria Rubella Measles Tetanus Mumps
Campers Name:
(please print) I, hereby give my consent to Delaware

(please
If print) I, for your child to receive medication during camp, please do the following:
it is necessary hereby give my consent to Family
Attractions, who will be caring for my child, to arrange for emergency/medical/dental care and treatment
(including diagnostic
A Medication procedures)
Form which necessary
authorizes to preservemedication
staff to administer the healthmust
of mybechild. I acknowledge that I am responsible for all reason-
completed.
able charges in connection with any care and treatment rendered.
2. Send medication in the original container (with date) properly labeled with the following information:
Correct name of individual receiving medication
Medical Instructions
Time medication is to be taken
If it is Amount of dosage individual is to receive
necessary for your child to receive medication during camp, please do the following:
1. Give the medication to the camp coordinator (or send the medication to camp with an adult if you are unable to bring it yourself ).
A Medication for
Authorization Form which authorizes
Summer Camp(s) staff
and to administer
Extended medication must be completed.
Care
2. Send medication in the original container (with date) properly labeled with the following information:
I understand that Delaware Technical Community College will not assume responsibility for accidents and/or medical or den-
talCorrect name of individual receiving medication
expenses received as a result of participation in the camp/s.
I give permission to Delaware Technical Community College to dispense the medication(s) listed on the Medication Administration
Time medication is to be taken
Form,
Amount of dosage individual is to receive
if any, to my child according to the information provided above. In the event that the emergency contacts cannot be reached,
I hereby grant Delaware Technical Community College permission to give whatever immediate treatment is necessary and/or take my
Authorization
child to thefor Summer
nearest Camp(s)
Hospital and Extended
Emergency Room. On Care
behalf of myself and my child, I release Delaware Technical Community College, its
I understand that Family Attractions not assume
will responsibility
for accidents
and/or medical or den-
tal expenses received as
medication with respect to my child. a result of participation in the camp/s.
I give permission to
Family
to
Attractions dispense
the medication(s)
listed on
the Medication Administration

Form, if any, to my child according to the information provided above. In the event that the emergency contacts cannot be reached,
I understand that no part of my tuition will be returned if my child should be dismissed from camp.
I hereby grant Family Attractions
permission
to
give whatever
immediate
treatment
is necessary and/or
take my
child to the nearest Hospital Emergency Room. On behalf of myself and my child, I release Family Attractions, its
trustees,
to officers,
the College. faculty,
This includes and(but
employees from any
is not limited and all claims
to) newspaper, arising from
television emergencyI treatment
and brochures. waive the rightand/or
to administration
approve such usesof
medication
and I releasewith respect
Delaware to my child.
Technical Community College from any liability in connection therewith.
Permission is hereby granted for my child to attend all scheduled field trips and off-campus activities scheduled in connection
I understand that no reduction in the tuition will be made for late arrival or early departure.
with
I understand that no part of my tuition will be returned if my child should be dismissed from camp.
the camp. I understand and acknowledge that participation in the camp and related activities carries with it the possible
I give Family Attractions
consent
to use the name and/or photograph/video
of my child for inclusion
in promotional and informational and other materials which the camp or its staff in its sole discretion consider to be of benefit
to the camp. This includes (but is not limited to) newspaper, television and brochures. I waive the right to approve such uses
and I release Family Attractions from any liability in connection therewith.
child
Permission is hereby granted for my child to attend all scheduled field trips and off-campus activities scheduled in connection
inflicts upon any person or upon the College facilities during participation in the camp.
with the camp. I understand and acknowledge that participation in the camp and related activities carries with it the possible
Deposits: The first fifty dollars ($50) of your camp payment is considered a deposit to hold your childs camp seat. Deposits are
risk of physical injury.
nonrefundable but it isOn behalf that
possible of mythe child, I assume
deposit may allbe such risk of physical
transferred according injury and
to the herebypolicy
Transfer release and forever discharge
below.
Family Attractions, its trustees, officers, faculty, and employees from any and all liability, claims, ex-
penses
over andorabove
lossesthearising
$50 from
deposit.bodily
Youinjuries
must make or damage to people
your request or property
in writing resulting
to Workforce from my childs
Development andinvolvement
Communityand partici-via
Education
pation in the camp. I further acknowledge and agree that I will be fully responsible for any and
U.S. mail, fax or email at the address/number located on the previous page. The request must be received by the close of business all losses or damages that my on
child inflicts upon any person or upon the camp facilities during participation in the camp.

I have carefully read all of the information, policies and procedures above and in the camp booklet (and/or website) and I agree to all
the terms and conditions. I am the legal guardian of the camper.

parent/Guardian Signature: Date:


2017 Off-Campus
2015 Off-CampusActivities
ActivitiesPermission
Permissionand
andRelease
Release Form
Form 6 of 6

Camp Transportation: Certified and licensed bus company to be determined by Family Attractions.

To Be Completed by Guardian:

Name of Child: Age:

I authorize the Family Attractions to provide my child with transportation to and from the camp.

List All Special Needs or Problems of Child Requiring Special Attention During Transportation Provided by
Family Attractions for the Camp:

I, the undersigned parent or guardian of , (print Name)


hereby grant permission for my child to participate in all of the activities, including those occurring off of property
owned or controlled by Family Attractions, scheduled for the camp. My permission extends to all activities listed on
this form or which may occur during the course of the camp. My permission includes the transportation listed
above as provided by Family Attractions unless I have indicated otherwise on this form. In the event that I have
chosen to arrange my childs transportation to and from the camp, I acknowledge that Family Attractions, its
employees, agents, and trustees, have no liability arising out of and from the transportation of my child to and from
these activities.

I further understand that all of the terms, conditions, and information contained in the 2017Family Attractions Camp
Authorization Form as submitted by me on behalf of my child, including the assumption of the risks of camp
activities, medical authorization, promotional authorization and such related releases of liability shall apply during
my childs participation in the activities occurring off of property owned or controlled by Family Attractions
scheduled for the camp as well as during Family Attractions transportation of my child in conjunction with these
camp activities.

I HAVE CAREFULLY READ ALL OF THE INFORMATION ON THIS FORM AND VOLUNTARILY AGREE TO ALL TERMS
AND CONDITIONS. I AM THE LEGAL GUARDIAN OF THE CAMPER AND UNDERSTAND THAT THE INFORMATION,
TERMS, AND CONDITIONS CONTAINED ON THIS FORM SHALL SERVE AS A RELEASE AND ASSUMPTION OF LIABIL-
ITY FOR MY HEIRS, EXECUTORS, AND ADMINISTRATORS.

Signature: (Mother, Father or Legal Guardian) Date:

http://go.dtcc.edu/swCamps 15

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