Summer Spanish Camp:
July 31st-August 4th 2017
Rising First grade through rising 6th grade
Location: Lower Level of the RESH Spanish Room
Time: 9 am—3pm
Fee: $250
Family discounts available
Please contact Sra. Martinez at
[email protected] for more information.
Camp Description
This camp is a week of Spanish immersion classes where students can learn or review the basics of the
Spanish Language. Every year, our new Gerstell Students get overwhelmed as they try to catch up with
their peers who have been learning Spanish since Pre-Kindergarten here at Gerstell Academy. I feel as
though this camp will lower anxieties for new students and their parents. Plus, current students at
Gerstell who need some extra help with the Spanish Language could use their leadership to refine their
Spanish, and even help their peers and younger students which will help build a new level of confidence.
Subjects:
Greeting
Numbers
Colors
Alphabet
Clothing
Days of the Week
Animals
Food
Games:
Bingo
Fashion Show
Make Food
Crafts:
Pinatas
Maracas
Masks
Dance:
Salsa
Mambo
Merengue
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- -- - - -- -- - - -- -- - - -- -- - - -- -
Camper’s Name: _____________________________________ Entering Grade: __________ Age: ______
Address: __________________________________________________________________________________
Parent/Guardian’s Name: __________________________________________________________________
Email: ____________________________________________________________________________________
Phone Number: ___________________________________________________________________________
Signature: ________________________________________________________________________________
A confirmation email will be sent after receiving your registration.
Please make checks payable to: Gerstell Academy
Mail checks to: 2500 Old Westminster pike, Finksburg, MD, 21048
Cancellation Policy: Due to the cost of supplies a cancellation fee of $100 will be applied to all
cancellations and refunds. If you cancel after July 1st, then you will not be eligible for any refund.
Gerstell Academy – Spanish Immersion Camp - 2017
The camp will be held at Gerstell Academy located at the address below:
2500 Old Westminster Pike
Finksburg, MD 21048
410-861-3000  Toll Free 1-866-861-3300  Fax 410-861-3006
EMERGENCY, MEDICAL, AND LIABILITY RELEASE FORM 2016
This form is to be completed by Parents.
(Please print)
CAMPER’S NAME: _______________________________________________(_______________________)
Last
First
Middle
Preferred Name
Camper’s Grade and Age: _____/______ Date of Birth: ____________ Social Security # xxx-xx-xxxx
Camper’s Residence: _____________________________________ ___________/______ _____________
Street address
City
State
Zip code
With whom does this student/camper reside?
_____Both Parents _____Mother _____Father
_____Guardian
TO SERVE YOUR CHILD IN CASE OF ACCIDENT OR SUDDEN ILLINESS, PLEASE FURNISH THE
FOLLOWING REQUIRED INFORMATION.
(1st CONTACT)
Parent/Guardian:
Employer:
Address:
Home:
Work:
Cell:
Pager:
Email:
(2nd CONTACT)
Zip
Parent/Guardian:
Employer:
Address:
Home:
Work:
Cell:
Pager:
Email:
Zip
PLEASE LIST TWO NEARBY RELATIVES OR NEIGHBORS WHO WILL ASSUME TEMPORARY CARE
OF YOUR CHILD IF YOU CANNOT BE REACHED:
Name:
Relationship: ________________
Home Number:
Address: _____________________________________________________ Cell Number:
Name:
Relationship: ________________
Home Number:
Address: _____________________________________________________ Cell Number:
MEDICAL INSURANCE INFORMATION:
Name of Main Insured Person(s):______________________ Insurance Company Name:
Insurance Company Address:
Medical Insurance Policy Number:
Group #:____________________________
Medical Insurance Telephone Number:
Family Physician:_____________________________ Telephone number:
Family Dentist:_______________________________ Telephone number:
Hospital Choice:
Food Sensitivities:
Drug Sensitivities:
Pg. 1 of 2
Athletic Activities to be Restricted:
Special Medications or Dietary Regimen to be Continued:
All medications to be taken at camp must be done through the director of the camp.
List any health conditions such as heart disease, diabetes, epilepsy, allergies, eye or ear problems, or any chronic
problems etc.:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
DISCRETIONARY ITEMS The director or designee may administer the following over-the-counter items to this child as
needed: (Check those we MAY give) Neosporin _____, Peroxide _____, Throat Lozenges_____, Anti-itch lotion or spray
(Cortisone) _____, Sunscreen _____, Rubbing Alcohol _____.
___________________________________________________________________________________________
AS A GENERAL RULE, GERSTELL – SPANISH IMMERSION CAMP WILL ATTEMPT TO CONTACT THE
PARENTS, LEGAL GUARDIANS, ASSIGNED RESPONSIBLE RELATIVES OR NEIGHBORS FIRST. IN THE
EVENT CONTACT CANNOT BE MADE, I UNDERSTAND AND HEREBY AUTHORIZE AND CONSENT THE
DIRECTOR OF GERSTELL – SPANISH IMMERSION CAMP, OR HIS/HER AGENT TO OBTAIN
EMERGENCY MEDICAL TREATMENT FOR MY CHILD.
I FURTHER AGREE TO PAY AND TO HOLD GERSTELL SPANISH IMMERSION – CAMP AND GERSTELL
ACADEMY HARMLESS ON ACCOUNT OF ANY MEDICAL, DENTAL, HOSPITAL, TRANSPORTATION OR
OTHER RELATED CHARGES INCURRED ON BEHALF OF THE CHILD.
___________________________________________________________________________________________
WAIVER AND RELEASE:
Please read this form carefully and be aware that by registering for and having your child participate in the
Gerstell – Spanish Immersion Camp, you will be waiving all claims for injuries your child might sustain arising out
of his/her participation. Please complete this form. You will not be admitted to camp without this form completed.
I recognize and acknowledge that there are certain risks of physical injury to participants in Gerstell camps and I voluntarily
agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward may
sustain as a result of said participation. I further agree to waive and relinquish all claims against the Gerstell – Spanish
Immersion Camp, its affiliates and Gerstell Academy Inc., Freven Foundation Charitable Trust and its affiliates, camp
directors, volunteers, and camp employees that I or my minor child/ward may have (or may accrue to me or my minor
child) as a result of his/her participation.
I do herby fully release and forever discharge Gerstell – Spanish Immersion Camp, its facilities and Gerstell Academy Inc.,
Freven Foundation Charitable Trust, from any and all claims for injuries, damages or loss that my child or I may have or
which may accrue to me or my minor child and arising out of, connected with, or in any way associate my child’s camp
participation.
I understand that the Gerstell – Spanish Immersion Camp retain the right to use for publicity and advertising purposes,
photographs of campers taken at camp.
I have read and fully understand the above waiver and release of all claims.
Authorized Parent/Guardian Signature
Date
Participant’s Name (Printed)
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