Summer Camp Registration 2010

Camp Policies
Cancellation
Changes or cancellations must be made in writing at least two weeks in advance of the camp start date to
receive a refund. A $25 cancellation fee per person per half-day camp will be deducted from the refund
amount. Cancellations made less than two weeks in advance will not receive a refund. Day Camp
reserves the right to cancel any camp two weeks prior to the start date due to low registration numbers. In
this case, participants will receive a full refund.

Camper Expectations
Day Camp programs are built on respect, choice and participation. Parents and children ages 6 and older
must sign a behavioral expectations form prior to camp. If a camper is asked to leave due to behavioral
considerations, camp fees will be forfeited with no refund. Parents are strongly encouraged to note special
needs on the registration form so our camp team can discuss them with parents in advance. Preschool
campers must be potty trained (no pull-ups) and bring a change of clothes to camp each day.
Lunch & Snack
Campers should bring their own snack for each camp they are attending. Campers who are here all day
should also bring their own lunch. In consideration of children with allergies, please do not send any food
containing nuts or peanut butter.

Late Pick Up
In the event that parents arrive to pick up children past the scheduled times, a monetary fee may be
imposed.

Financial Assistance
Day Camp offers a limited number of scholarships to families that demonstrate financial need. To receive
an application, call the camps & workshop coordinator at 760-325-1779. Monthly payment plans are also
available upon request.


Signature_________________________________
Print Name_________________________________
Date: _____/______/________

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Summer Camp Registration 2010

CAMPER REGISTRATION INFORMATION



Camper's First Name
____________________________

Camper's Last Name
____________________________
Camper's Nickname
____________________________
Gender:
______________
Camp Age
____________
Date of Birth
___________________
T-shirt Size:
Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large
***Please list any medical or special behavioral considerations that we should be aware
of, including but not limited to allergies, medication, or physical challenges.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________________________________________
Please Note: Camp staff can only administer medication prescribed to a camper by a physician, specifically for the
purpose of treating an ongoing condition that requires on-demand, time-sensitive dosing to prevent a medical

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emergency. Any medical or behavioral conditions may result in a proactive call from the Camp team to help
determine the best way to accommodate your child's needs.
PARENT/GUARDIAN REGISTRATION INFORMATION
*Parent/Guardian's First Name

__________________________________
*Parent/Guardian's Last Name

__________________________________
*Address
____________________________________________________
*City

_____________________________________________________
*State

_______________________________________________________
*Zip Code

_______________
*Home Phone

________________________
Work Phone

_________________________
Cell Phone

__________________________
*E-mail Address

_____________________________
Additional Parent/Guardian Name

_____________________________
Additional Parent/Guardian Phone

_______________________________

CARPOOL INFORMATION
Others authorized to pick up your child:
Name #1__________________________
Phone #1__________________________
Name #2___________________________
Phone #2___________________________

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MEDICAL INFORMATION
Our primary concern is the health, safety and well-being of your child. For this reason,
please provide the following information:
*Name of Camper's Physician
_____________________________
*Physician's Phone Number
_____________________________
*Non-parent Emergency Contact
______________________________
*Relationship to Camper
______________________________
*Daytime Phone Number
_______________________________

Please Read and Sign Below:
.I have read and understand the Camp Policies. I give permission for my child to participate in this program and all
activities, including off-campus activities.

. I understand Camp may photograph my child during the camp. Registration grants permission to use photos in
Camp publications and approved media sources unless I request otherwise in writing.

. I release Marbles Kids Museum and any of its agents or employees from any and all liability for claims and
damages which might arise as a result of personal injuries received in connection with participation in the activities
associated with this program.

. I certify that my camper's medical information is complete and accurate to the best of my knowledge. I give
permission for a Camp member to seek emergency care for my child in my absence.

Signature_________________________________
Print Name_________________________________
Date: _____/______/________

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