CAMPER INFORMATION:
Please print and complete all information
Last: ___________________________________ First: _____________________________ Middle: ________________________________
Tween​ ​☐ ​Senior​ ​☐​ ​Kindergarten Readiness*​ ​☐ Gender: M​☐ F☐
​DOB: __________________________
Allergies: _______________________________________________________________________________________________________________
Medications/Medical Conditions: ____________________________________________________________________________________
FAMILY/LEGAL GUARDIAN CONTACT INFORMATION
Last: ____________________________________
First: ______________________________________
Cell phone: _____________________________
Work phone: ______________________________
Email: ___________________________________________________________________________________________________________________
Please return registration form along with a check for camp fees to the Community Day School Front
Office.
Session
Session 1
Session 2
Session 3**
Session 4
For Business
Dates
June 12-
Day(s)/Cost
9 AM - 2 PM
(select choice)
☐ ​5 Days: $200
Early Morning Care
8-9 AM
​ After Care
2 -5 PM
​Swimming
Tweens &
Seniors, only
(select choice)
☐ ​5 Days: $100
(select choice)
☐ ​5 Days: $112.50 ☐ ​$36
☐ ​5 Days: $400
☐ ​5 Days: $200
☐ ​5 Days: $225
☐ ​5 Days: $360
☐ ​5 Days: $180
☐ ​5 Days: $202.50 ☐ ​$36
☐ ​5 Days: $400
☐ ​5 Days: $200
☐ ​5 Days: $225
☐ ​5 Days: $200
☐ ​5 Days: $100
☐ ​5 Days: $112.50
June 16
June 19-
☐ ​$36
June 30
July 3July 14
July 17July 28
Office Use Only
*​Kindergarten Readiness is for students entering Kindergarten the 2017-2018 school year
** No Camp on Tuesday, July 4, 2017
☐ ​$36
Community Day School Summer Camp Program - ​Camp Terms 2017
Camper’s enrollment in the Hershorin Schiff Days Schools of Tomorrow (DBA Community Day School) Summer Camp Program (hereafter referred to
“Camp”) is subject to the general statements, rules, regulations, conditions, traditions, and financial terms contained in this Contract.
Enrollment
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It is important to note that camp registration is on a first come, first served
basis.
Children will only be enrolled in the program designated for their age group.
Only children entering Kindergarten will be accepted into the Kindergarten
Readiness program. Camp Steamy is for children who have entering
Kindergarten through those entering 5th​ ​ grade. ​Ages are based on a camper’s
age as of September 1.
The Counselor in Training (CIT) program is for children who completed 5th​
through 8th​ ​ grade.
For children not yet toilet trained, parents need to furnish diapering supplies
on a regular basis.
Parent agrees to allow Student/Campers name, photograph, and information
to be used by Camp for use in publications, promotional materials and
website, without compensation and without prior notice. Parent releases and
holds Camp harmless from any liability stemming from the use of Camper’s
name, photograph, or information.
Registration and Tuition
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A separate, completed registration form and executed contract is
required for each Camper.
Only registration forms, accompanied by a contract and
full payment for registered sessions, will be accepted.
Camp enrollment packets and full payment are due by the Thursday prior to
each session.
There is a $25 fee for returned checks.
Campers with an account balance with Community Day School will not be
able to enroll in camp until their outstanding account balance is resolved.
Camp is staffed according to the number of children scheduled to attend each
session. For this reason, there is no reduction of tuition for days missed due
to illness, holiday or vacation.
Early and After Care are available on a pre-planned, pre-paid basis. Staffing
is planned based on enrolled students.
Unplanned, emergent needs for early or after care may be accommodated
with notice to the Camp Director. Payment is due at the time the camper is
picked up.
Participation in Camp
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Each Camper will arrive at Camp at a time consistent with to the scheduled
program start time and prepared with appropriate clothing, footwear and
supplies (i.e., sneakers, towel, sunscreen, etc.) for the planned Camp
activities. Camp staff may limit a Camper’s participation in specific activities
if they are deemed to be “unprepared” by the Camp Director.
Campers should bring a lunch and camp appropriate snacks each day.
Camp lunches must be kosher-style, may not contain dairy and meat
products in the same meal and may not include pork products or shellfish.
For Camp STEAMY campers, pizza is available each Friday. Pizza orders
must be received, and paid in advance, by the end of camp on Thursday.
Parent acknowledges they and camper have been advised not to bring
non-essential items to Camp.
The Camp is not responsible for damages to, or loss of, personal
belongings.
In registering for Camp, parent acknowledges that their child will be involved
in a variety of activities, including playground and other physical activities,
special programs etc.
Illness – For your child’s well-being, and out of respect for our other students
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and teachers, please refrain from bringing a sick child to CDS. Children
demonstrating signs of illness will be sent home from the program. If called to
pick up your child you or an authorized emergency contact are expected to do
so within 30 minutes. If we are unable to reach a parent, we will call the
emergency contacts noted below. Illness is defined as any condition or
behavior that prevents them from fully engaging in program activities; a fever
of 100 F; a green runny nose; or vomiting. Any child sent home from the
program will be unable to return until they are symptom free, without
medication for 24 hours.
If in the opinion of a properly licensed and practicing physician, Camper
needs medical or surgical services which require Parent’s preauthorization or
consent, Parent hereby authorizes, appoints, and empowers the Camp to act
as Parent and furnish such consent on Parent’s behalf. Parent confirms that it
is Parent’s desire that Camper be furnished with such medical or surgical
services as soon as reasonably possible after the need arises. Parent also
releases and holds the Camp harmless from any liability, which might arise
from the giving of such consent. Parent agrees to reimburse the School/Camp
for any medical expenditure made on Student/Camper’s behalf.
Camp has a philosophy of self-discipline, respect and safety. Camp expects
respectful, safe and gentle behavior at all times. Both physical and verbal
compliance to this term is required. Camp will apply this provision in a
developmentally appropriate manner to the age group within a given Camp
session.
Campers who display unacceptable behaviors, or do not perform to the
standards, will be counseled and redirected by Camp staff. If infraction(s) is
deemed severe by the Camp Director, the Camper’s parents will be called
and the Camper will be dismissed early from the daily session. Parents will
pick-up dismissed campers within 30 minutes of being notified.
Campers dismissed from Camp may not resume attendance until the Camper,
Parent and Camp Director have discussed the infraction and have agreed the
Camper may continue to participate in Camp. A second infraction will result in
the Camper being expelled from Camp. Campers who are dismissed/expelled
are not entitled to a refund or credit or release from financial obligation.
Expelled Campers may not enroll for any subsequent camp sessions during
the 2017 Camp program.
Drop Off / Pick Up Policy
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Sign in/Sign out policy – Parents are required to sign Campers in and out
every day. Campers may not walk themselves into the program (with the
exception of CITs).
Drop off​ ​- Campers are expected to be dropped off and ready for camp no
later than the start time of their program day. Summer camp is not a “drop-in”
daycare center. Late arrivals disrupt scheduled activities.
Pick up - Campers are expected to be picked up at the scheduled end time,
unless Camper is registered for after care.
Camp will not release a Camper to persons who are not on the pickup list or
anyone who appears to be under the influence or ability altering substances.
A Parent will be contacted.
Lateness – When our camp program closes your child will automatically be
escorted to our After Camp program at which time those fees will begin to
occur. Late pick-up fees after 5pm will be assessed at a fee of $1 per
minute per child. If a Camper remains more that 30 minutes, the Emergency
Contact or others on the pickup list) will be called to pick them up. If the
Camper remains 60 minutes, and no one can be confirmed for pick up, the
Police will be called. ​Under no circumstances will a Camper be released
to a person not on the Authorized pick-up list without prior, written
permission from the parent or guardian
By registering for Camp, I hereby give permission for my child to participate in all related activities. I understand it is my responsibility to provide
Camper’s accident and health coverage while they are attending Camp.
My signature below indicates that 1) I agree to all Camp policies and terms written, posted and verbal and 2) acknowledge that I am the financially
responsible party for all tuition, fees and costs associated with my child’s participation in Camp. Any questions /concerns have been addressed with the
Camp Director prior execution of this contract.
Signature of Parent or Guardian:_______________________________________________
rev 2-21-17
Da​te:______________________
EMERGENCY PARENTAL CONSENT
CAMPER / CIT INFORMATION
Last: _______________________________________________________
First: _______________________________________________
Gender: M​☐ F☐
​DOB: ________________________________________________
Allergies: _______________________________________________________________________________________________________________
Medications/Medical Conditions: ____________________________________________________________________________________
LEGAL GUARDIAN INFORMATION
Last: _______________________________________________________
First: ______________________________________________
Home phone: _________________________ Work: ______________________________ Cell: _____________________________________
Email: ___________________________________________________________________________________________________________________
LEGAL GUARDIAN INFORMATION
Last: ________________________________________________________ First: ____________________________________________________
Home phone: _________________________ Work: ______________________________ Cell: _____________________________________
Email: ___________________________________________________________________________________________________________________
Emergency Contacts:
_____________________________________ ______________________ _____________________________________ ______________________
_____________________________________ ______________________ _____________________________________ ______________________
Authorized Pick-ups:
_____________________________________ ______________________ _____________________________________ ______________________
_____________________________________ ______________________ _____________________________________ _____________________
In the event of a life threatening situation or a serious injury, the School or its representative has my permission to contact the appropriate
emergency medical services. The medical services have my consent to provide necessary treatment or transportation for my child. I then request
that I be notified of the situation. I, the undersigned, will be responsible for emergency cost. In the case of an accident or illness where immediate
emergency care is not judged to be needed, but where my child is unable to remain at school, I request that the school contact either my spouse or
me to arrange transportation for my child. If the school is unable to contact my spouse, or me, I request that one of the persons listed as an
emergency contact be called and requested to care for my child.
The school must be able to reach either parent at all times. Students must be picked up 20 minutes after notification.
______________________
​Date
______________________
​Date
_________________________________________________________________
Legal Guardian Name (print)
_________________________________________________________________
Legal Guardian Name (print)
_____________________________________________________
Legal Guardian Signature
_____________________________________________________
Legal Guardian Signature