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Camp Enrollment
Summer Camp Enrollment Application
Please submit one enrollment form for each child.
Mother’s Name
Father’s Name
Home Phone
Address
City
State
Zip
Email address
Father’s Employment
Work Number
Cell#
Mother’s Employment
Work Number
Cell#
Child’s Information
Child’s Name
Age
Grade (ex: rising 2nd)
Camp Enrollment Level
Splash (Preschool - Morning)
Fit2Splash Half Day Camp
Breezers (1 – 3 grade)
Summer Sun Crew (4 – 6 grade)
Rural Hill / HFFA (Rising 1st - 5th grade)
Is your child on any medication?
YES
NO
If yes, what?
Is your child up to date on shots?
YES
NO
Is your child allergic to any medication?
YES
NO
If yes, what?
Does your child have any food allergies?
YES
NO
If yes, what?
Please list any other allergies
Please list any other medical conditions
Person responsible for paying for childcare
Persons responsible for picking up child/relationship to child
Emergency Care Information
Name of child’s doctor
Office Phone
Address
Name of child’s dentist
Office Phone:
Address
Hospital preference
Phone
If neither father nor mother (or guardian) can be contacted, call:
Name
Home Phone
Office
Relationship to Child
Name
Home Phone
Office
Relationship to Child
Emergency Action Release and Consent to Treat
I give HFFA and the Summer Camp team members permission to treat or authorize treatment on behalf of my child in the event emergency medical care is needed. I understand that when possible, every attempt will be made to reach me or my emergency contacts prior to treatment. I understand that HFFA and it’s employees will call for and authorize emergency care in my absence if necessary.
Please note:
Registration fees will be collected at time of registration.
Non-refundable 10% deposit required for each week signed up for at time of registration.
Weekly automatic drafts are required for
all
campers.
Weekly payments will be automatically drafted each week on the Friday prior to the week your child is attending.
Payments are for full weeks only, we do not prorate camp dues. If your child misses a day you must still pay for the full week of camp.
If you have 2 children attending camp you will receive a $20 discount on each additional child attending camp (For children split between Preschool camp and Traditional camp the Preschool camper will be discounted).
There is a $1 per minute late fee assessed when your child is picked up late. You will be required to sign acknowledgement of this and it will be charged with your next week’s tuition.
Two weeks notice must be provided if you are unable to attend camp or you will be charged even if your child does not attend.
All families must complete a drafting form.
I understand the above stated and agree to follow the payment procedures listed.
For questions on your application and confirmation of application & registration status, how would you like to be contacted?
Email
Home Phone
Cell Phone
Verification Code
Type Verification Code