Event Registration

2018 Summer Camp Registration

First and Last name of Participant

Current Age

Date of Birth

Current GradeMust be K - 5th grade(for children currently in Kindergarten - 5th grade or home school children ages 5-11)

Pickup PersonIf nobody other than self, fill in Nobody

Email Address

Home AddressStreet address, City, Zip

Home Phone Number

Cell Phone Number

Work Phone Number

Please Check the Weeks Your Child Will Attend

Choose oneFULL or HALF day registration - choose one

$100 per week 9 am to 3 pm
$60 per week 9 am to 12 pm

NOTE: Priority will be given to registrants who register for FULL DAY for the full 6 weeks.The first week’s payment $100.00 is due upon registration (first week registration is NOT refundable). All accounts MUST be paid in full prior to June 15th.

*Please make checks/money order payable to: Delanco Recreation Commission. We do not accept cash payments. All registrations and payments can be made by using PayPal (see website), dropped off to your child’s teacher or mailed to: Summer Camp Program770 Coopertown Rd. Delanco NJ 08075.

I understand that the first week payment is NOT refundableI understand NOT refundable

I understand that my balance MUST be paid prior to June 15thI understand my balance

NOTE: Camp is limited to 25 students per group. Register EARLY!! There will be two age groups. K to 2nd grade and 3rd to 5th grade. Lunches will NOT be provided.

As a parent or guardian of Registered child, a minor, I give my permission for him/her to participate in Summer Day Camp Program inside Pearson Elementary School, Field Trips outside of Pearson Elementary School AND/OR Other Events sponsored by the Delanco Recreation Commission. I herewith authorize treatment by a qualified medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if treatment is delayed. The authority is granted only after a reasonable effort has been made to reach me.

Parent Permission/Emergency Consent for Treatment

Family Physician

Phone Number

AlergiesAllergies, chronic illness, medicines, or other medical conditions the medical staff should be aware of

Additional Emergency Contacts

This Permission and Consent for Treatment form is completed and signed of my own free will for the purposes of allowing particiaption in the recreation activity specified and for authorizing medical treatment under emergency circumstances in my absence.

Name one

Relationship one

Phone Number one

Name two

Relationship two

Phone Number two

Name of Parent or Guardian

Email Address of Parent or Guardian

Date

by clicking this box you are confirming that all information provided is true and up to dateCheck Box for Signature

Anti-Bullying Policy and Summer Camp Behavior Agreement

The Township of Delanco Parks and Recreation Department is committed to a safe and civil educational environment for all of our campers and staff, free from harassment, intimidation or bullying. “Harassment, intimidation or bullying” means any intentional written, verbal or physical act, when the intentional written, verbal or physical act:

Agreement

Physically harms a camper/staff member or damages the camper’s/staff member’s property; or
Has the effect of substantially interfering with a camper’s education or staff member’s duties; or
Is severe, persistent, or pervasive that it creates an intimidation or threatening educational environment; or
Has the effect of substantially disrupting the orderly operation of the camp.

Nothing in this policy requires the affected camper/staff member to possess a characteristic that is a perceived basis for the harassment, intimidation, or bullying, or other distinguishing characteristic. Harassment, intimidation or bullying can take many forms including: slurs, rumors, jokes, innuendo’s, demeaning comments, drawing cartoons, pranks, gestures, physical attacks, threats, or other written, oral or physical actions. “Intentional acts” refers to the individual’s choice to engage in the act rather than the ultimate impact of the action(s).

This policy in not intended to prohibit expression of religious, philosophical, or political views, provided that the expression does not substantially disrupt the education environment. Many behaviors that do not rise to the level of harassment, intimidation, or bullying may still be prohibited by other policies, rules, or regulations.

Counseling, corrective discipline, and/or referral to law enforcement will be used to change the behavior of the perpetrator and remediate the impact on the victim. False reports or retaliation for harassment, intimidation or bullying also constitutes violations of this policy.

The Director of the Township of Delanco Parks and Recreation Department is authorized to direct the development and implementation of the procedures addressing the elements of this policy, consistent with the complaint.

Township of Delanco Parks & Recreation Department Summer Camp Behavior Agreement

Parents: Please take a moment to review the following agreement with your camper. Signify that you both understand and agree to each statement by initialing the box. This form must be returned with the camp application and payment in ordered to be processed.

Behavior Agreement

I will arrive and remain at camp with a positive attitude, open to meeting new people and trying new activities.
I will work with my counselors and fellow campers towards creating an environment that is safe and welcoming for each of us.
I understand that doing intentional harm or bullying another camper, either physically or emotionally is grounds for dismissal from camp.
I understand that although I may be able to solve some conflicts on my own, the counselors are always ready to listen and assist if there is a problem. I understand that my counselors and all of the camp staff need and want to help but can only do so if I am willing to share any concerns that I have with them.
I will remain with my counselor and partake in the activities of my session as required.
I will use appropriate language and understand that the use of excessive, deliberate, profane language will not be accepted.
I will leave my cell phone and other electronic devices at home. I understand that if there is an emergency the camp staff will be happy to allow me to use the phone and will pass on any urgent messages from home.
I will be respectful of the property and personal space of other campers and camp staff.
I will not possess smoking materials, lighters, matches, illegal drugs, alcohol or weapons of any kind on county parkland.

The Township of Parks and Recreation operates on a three-strike policy. The first infraction of the behavior management will result in a verbal warning between staff and camper(s). The second infraction will result in a time-out/loss of field trip privilege and notification of the parent at the end of the camp day. A third infraction will result in a conference between the camper(s), parent(s), Camp Director, a Park Ranger and the Director of Parks (if needed). This third infraction can result in the removal from the camp program. Refunds are not given for any camper who is sent home/removed from the program for disciplinary reasons

A zero tolerance policy is enforced in regards to Physical Aggression. Any camper who commits an act of physical aggression against another camper, staff member, or anyone else will be removed from camp. As a parent, you will be responsible for picking-up your camper within one hour of the decision to dismiss your child from camp. Depending on the act of aggression, your child may not be able to return to camp for the remainder of the camp program.

By signing below, I am stating that I have read and agree to abide by, all policies contained with the antibulling policy and behavior agreement. Furthermore, I certify that I have discussed all the policies, and their meanings and consequences, with my child(ren).

by checking this box you agree to all terms in the above AntiBullying PolicyCheck box to agree to AntiBullying Policy

I am utilizing the Paypal feature and I will be paying the additional fees for PaypalI am utilizing Paypal

2018 Summer Camp Registration

Parent Permission/Emergency Consent for Treatment

Additional Emergency Contacts

Anti-Bullying Policy and Summer Camp Behavior Agreement

Township of Delanco Parks & Recreation Department Summer Camp Behavior Agreement

Note: You will be opted to pay through Paypal on the next page after clicking Submit.