Camper Registration - Baba Sports Camp

Family Name *

First Name

Last Name

Grade Last Completed *

Contact Information

Address *

City *

State *

Zip *

Name of Parent or Guardian *

Phone Number(Home)

Phone Number(Cell) *

Phone Number(Work)

Emergency Contact

List other contacts besides Parents/guardians

Contact Name *

Relationship * Relationship

Emergency 1 Phone Number(Home)

Emergency 1 Phone Number(Cell) *

Emergency 1 Phone Number(Work)

Contact Name

Relationship Relationship

Emergency 2 Phone Number(Home)

Emergency 2 Phone Number(Cell)

Emergency 2 Phone Number(Work)

Family Physician *

Physicians Phone *

Family Dentist *

Dentist Phone *

Insurance Information

The camper enrolled is covered by the following medical/hospitalization.

Name of Insurance *

Policy Number *

Group Number *

I/We the parent(s) or guardian(s) of the enrolling camper, certify that the camper is covered by adequate medical/hospitalization insurance for the duration of the camp season. I/We understand therefore, that the cost of medical services due to any injuries sustained by the camper will be the financial responsibility of the parent or guardian. *

Yes

Parent/Guardian Signature

Clear

Tuition and Enrollment Information

Number of Weeks Paid

Weekly Tuition

Daily Tuition

Daily Tuition Days

Select Weeks for Attendance *

7/2-7/6

7/9-7/13

7/16-7/20

7/23-7/27

Secondary Health Information

Answering these questions to the best of your knowledge will enable us to give your child the best care.

Will your child be taking any medication during camp? *

If yes, all medication must be given to a senior Counselor to be held for the duration of the camp.

What medications will they be taking? *

Why are taking this medication? *

Does your child have any allergies? *

Please list allergies *

Does your child have any allergies to medications? *

Please list allergies to medications *

Does your child have asthma? *

Do they use an inhaler? *

Does the camper have any physical limitations or chronic ailments that we should be aware of? *

Please list physical limitations or chronic ailments *

Has the camper been identified with any learning disabilities? *

Please list and explain learning disabilities *

Would they interfere with typical camp activities? *

Baba Sports Camp is a highly structured camp that requires children to stay with a group and follow the direction of counselors. Are there any behavioral issues that your child has that might hinder his/her full participation in our camp program? *

Please list behavioral issues

Date of last Tetanus shot *

Please list any additional comments that may be of assistance in helping us care for your child

The medical information I have provided, to the best of my knowledge is correct and the person(s) herein described has permission to engage all prescribed camp activities except if noted. *

Yes

Parent/Guardian’s Signature

Clear

My child/children are completely up to date with all their immunizations and physicals. *

Yes

Parent/Guardian’s Signature

Clear

Enrollment Regulations

Please read and sign verifying acknowledgment and agreement

Baba Sports Camp

ENROLLMENT REGULATIONS

The camp application must be sent with completed health form and appropriate fees.
The camper and parent(s)/guardian agree to abide by the rules and regulations set forth by Baba Sports Camp.
Baba Sports Camp reserves the right to terminate the enrollment of any camper whose physical or mental condition, conduct, influence or behavior is deemed by Baba Sports Camp unsatisfactory or detrimental to the best interest of the camp. Tuition is refunded on a prorated basis.
A $25.00 fee is charged on all returned checks.
The camper must be covered by medical and hospitalization insurance provided by the parent or guardian for the duration of the camp season.
The parent’s signature gives campers permission to participate and be transported by busses to Hatfield Aquatic Center.
Parents must ensure that the camper is wearing sneakers and appropriate attire daily, so that he or she can participate fully in the scheduled activities. This is also to prevent injuries that can occur from wearing sandals or flip-flops. Campers must bring a means to stay hydrated each day and sunscreen for those hot and sunny days. A small healthy snack is also recommended for break time between activity periods and lunch must be brought for full day campers in a cooler with a cold pack.
Participation in all activities is essential to your child’s optimum camp experience. Our counselors encourage every child to “try” and make attempts at all activities. We will communicate with you, if lack of participation becomes problematic.
Camp is not responsible for the equipment or personal belongings of campers. Digital devices (I Pods, etc.) cameras, jewelry, listening devices, ARE NOT TO BE BROUGHT TO CAMP.

Parent or Guardian gives permission to have photographs/slides taken of campers for use in printed materials (brochures, web site, etc.) or other media for promotional purposes only. *

Your Extended Hours Selection

Select Extended Hours Weeks *

7/2-7/6

7/9-7/13

7/16-7/20

7/23-7/27

EXTENDED HOURS REGISTRATION & ENROLLMENT

EXTENDED HOURS HAS A WEEKLY FLAT RATE PER FAMILY (NOT BY CAMPER) AND IRREGARDLESS OF THE AMOUNT OF DAYS USED.
1. AM ONLY ($50 PER WEEK)
2. PM ONLY ( $50 PER WEEK)
The $50 weekly charge applies to drop off for AM extended from 7:30am to 8:45 am and pick up from 3pm to 4 pm for PM extended
IF USING BOTH AM AND PM EXTENDED CARE ( $100 PER WEEK)
NOTE: LATE FEE CHARGE (4:01PM-4:15PM)- $25.00
BEYOND 4:15PM IS $5.00 FOR EVERY ADDITIONAL 5 MINUTES AND MUST BE PAID THAT DAY
USE OF EXTENDED HOURS ON AN EMERGENCY BASIS(1 DAY) MUST BE COMMUNICATED AND RESERVED WITH THE CAMP ADMINISTRATOR 1 DAY PRIOR TO USAGE.
AM OR PM FEE - $10.00 BOTH AM AND PM - $20.00
MUST BE PAID IN CASH THE DAY OF USAGE.
EXTENDED HOURS PAYMENTS ARE DUE BY JUNE 23rd, 2018

I wish to enroll my child/children for the 2018 camp season. I agree to comply with all of the terms of enrollment stated above. *

Yes

Parent/Guardian’s Signature

Clear

Code of Conduct

Please read and sign verifying acknowledgment and agreement