2022 Camp Registration

May 31st - July 1st daily or weekly for ages 4.5 to 9

8:00 a.m. to 12:30 p.m. with an option to stay until 2:30 p.m. for $20 per child

Camp numbers are limited to 20 Kids per day. IF YOUR CHILD IS ILL OR YOU SUSPECT THEY ARE NOT FEELING WELL, PLEASE DO NOT SEND THEM TO CAMP.

2022 Camper/Parent Contract

*If you have more children that you would like to signup, the form will prompt you after you click submit.
Each child must be entered separately.

Mother's Name*:
Home Phone*:
Cell Phone*:
Father's Name*:
Father's info
Email*:
Home Phone*:
Cell Phone*:

IN ORDER TO CLARIFY THE CAMP’S “STANDARDS OF BEHAVIOR” AND THE CAMP’S “DISCIPLINARY CODE” FOR PARTICIPATION, IT MIGHT BE HELPFUL TO REVIEW THE FOLLOWING ISSUES THAT OCCASIONALLY ARISE.
CAMPERS MAY BE SENT HOME FOR THE FOLLOWING REASONS:

KICKING, JUMPING ON OR PROVOKING FIGHTS WITH ANY MEMBER OF THE CAMP, STAFF OR PARENTAL COMMUNITY.
DISRESPECT TO STAFF, MEMBERS, OR OTHER CAMPERS
THROWING OF SAND, ROCKS OR ANY OTHER ITEMS THAT ARE NOT MEANT TO BE THROWN INCLUDING SHOES, CHAIRS, STICKS, ETC.
RUNNING AWAY FROM THE CAMP GROUP. COUNSELORS WILL BE TRAINED TO ENCOURAGE AND MOTIVATE CAMPER PARTICIPATION. HOWEVER, CAMPERS MUST UNDERSTAND THAT THEY ARE NOT PERMITTED TO RUN AWAY FROM THE CAMP AREA AT ANY TIME.
ROUGHHOUSING, HORSEPLAY AND VIOLENT GAMES WILL NOT BE A PART OF THE CAMP.
DISTASTEFUL, DEROGATORY OR SPITEFUL JOKES, COMMENTS AND STORIES ARE NOT ACCEPTABLE IN ANY ARENA OF THE CAMP PROGRAM.

IF A CHILD’S BEHAVIOR WARRANTS DISMISSAL FROM THE CAMP, MOM, DAD OR GUARDIAN WILL BE CALLED AND ASKED TO IMMEDIATELY PICK UP THAT CHILD. IF THE PARENTS ARE UNABLE TO RESPOND IMMEDIATELY, THE CHILD WILL BE SEATED IN THE POOL RESTAURANT UNTIL THE PARENTS ARRIVE. THE SECOND TIME A CHILD IS DISMISSED FROM CAMP, THE CHILD WILL NOT BE ALLOWED TO RETURN TO CAMP. THERE WILL BE NO REFUND OF CAMP FEES.

PARENTS PLEASE READ:

I UNDERSTAND THAT MY CHILD WILL BE SENT HOME FROM CAMP IF HE/SHE BREAKS ANY OF THE ABOVE RULES. AFTER BEING SENT HOME FROM THE CAMP TWO TIMES, MY CHILD WILL BE DISMISSED FROM THE CAMP FOR THE ENTIRE SUMMER SESSION. IF MY CHILD IS DISMISSED FOR BEHAVIOR RELATED PROBLEMS, SUCH AS THESE, THERE WILL BE NO REFUND OF CAMP FEES.
I UNDERSTAND THAT THERE ARE NO REFUNDS AFTER MAY 20th, 2022. ALL OF THE DAYS/WEEKS THAT I HAVE RESERVED FOR MY CHILD MUST BE PAID FOR.

I initial and understand the Standards of Behavior

Child

Name*:
DOB*:
Age*:

Male Female

Week 1: May 31st	Week 2: June 7th	Week3: June 14th	Week 4: June 21st	Week 5: June 28th

If Daily for Week 1 Insert Days Below:	If Daily for Week 2 Insert Days Below:	If Daily for Week 3 Insert Days Below:	If Daily for Week 4 Insert Days Below:	If Daily for Week 5 Insert Days Below:

PLEASE DISCUSS THIS CONTRACT WITH YOUR CHILD BEFORE HE/SHE INITIALS.
In order to clarify the Club’s “Standards of Behavior” and the “Disciplinary Code” for participation, it might be helpful to review the following issues, which occasionally arise.
I may be sent home for the following reasons:

Disrespect of Staff or other children
Continued use of electronics after a warning
Throwing of ROCKS or any other items that are NOT meant to be thrown, including SHOES, CHAIRS, STICKS, ETC.
Running away from the group. Staff will be trained to encourage and motivate participation by all of their kids. However, the children need to understand that they are not permitted to run away from the staff at any time.
Roughhousing, horseplay, violent games, dangerous stunts, foul language, uncouth jokes, improper conversations and inappropriate gestures will NOT be tolerated.

I initial and understand the Standards of Behavior

Payment Option

Your member account will be charged half in June.
You may withdraw your child from Summer Camp 2020 prior to May 29th for a 100% return of your registration fees.
After May 29th there are no refunds for the session. If a child does not come to camp on a day they are registered, they will be charged. The fee is based on registrations, not actual attendance.

Attending:
Optional after camp care until 2 pm for $10 per hour Please note days if you would like this care.
Member Account (Members Only)
*Member Number

Child's Medical Information

*MEDICAL INFORMATION IS IMPORTANT FOR OUR STAFF TO PROVIDE THE BEST POSSIBLE CARE FOR YOUR CHILD

*I DO HEREBY AUTHORIZE AND CONSENT TO ANY X-RAY EXAMINATION, ANESTHETIC MEDICAL OR SURGICAL TREATMENT RENDERED BY ANY MEMBER OF THE MEDICAL OR EMERGENCY DEPARTMENT STAFF LICENSED UNDER THE PROVISIONS OF THE MEDICINE PRACTICE ACT OR A DENTIST LICENSED UNDER THE PROVISIONS OF THE DENTAL PRACTICE ACT AND ON THE STAFF OF ANY ACUTE GENERAL HOSPITAL HOLDING A CURRENT LICENSE TO OPERATE A HOSPITAL FROM THE STATE OF ARIZONA.
IT IS UNDERSTOOD THAT THIS AUTHORIZATION IS GIVEN IN ADVANCE OF ANY SPECIFIC DIAGNOSIS, TREATMENT OR HOSPITAL CARE DEEMED ADVISABLE BY THE AFOREMENTIONED PHYSICIAN IN THE EXERCISE OF HIS/HER BEST JUDGEMENT. IT IS UNDER- STOOD THAT EFFORT SHALL BE MADE TO CONTACT THE UNDERSIGNED PRIOR TO RENDERING TREATMENT TO THE PATIENT, BUT THAT NONE OF THE ABOVE TREATMENT BE WITHHELD IF THE UNDERSIGNED CANNOT BE REACHED.

*Insurance Company under
which my child is covered:

*Physician Phone #:
*Pediatrician to Contact:

Additional Emergency Contacts:

Name/Home Numbers/Cell Numbers
Relationship and Other information:

List of Activities to be Omitted:
List Any Physical Limitations:
List Any Food Allergies:
List Any Recent Spells of Convulsions, Concussions or Loss of Consciousness:
List any Problems with Social or Motor Skills:
List any Special Medications (Insulin,Ritalin, ETC, ) that Must Be Taken while at Camp

*By typing your name in this box, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

If you have more children that you would like to signup, the form will prompt you after you click submit.
Each child must be entered separately.