temp-sc-camp-reg

2023 Summer Fun Days Camp Registration

2023 Summer Fun Days Camp Registration

Summer Program Location:
Amador High School Cafeteria
330 Spanish Street, Sutter Creek, CA 95685

REGISTRATION FORM

Student’s Full Name
Student's Full Name
First
Last
REGISTRATION:
Camp fee is $175 per week plus a one-time $25 registration fee. Extended hours are an additional $45 weekly.
Payment is due on Wednesday the week before each session begins.
Camp hours are: 8:00 am – 4:00 pm. Extended hours are 7:30 am – 5:30 pm.
Meals: ACUSD will provide breakfast and lunch, ACRA will provide two daily snacks.
Please select the weekly session of July 3-7 and/or select Extended Hours if needed (NOTE: Registration is FULL for all other weeks except July 3-7)

Parent or Guardian Information (1):

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Parent or Guardian Information (2)

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Child Pickup or Leave at Will Information:

Is your child allowed to leave at will?
If “Yes”, your child has permission to sign out on the daily log sheet. When your child leaves after signing out, he/she/they will not be allowed back into the program that day. Once the participant has signed out, the staff is no longer responsible for the participant or for his/her/their behavior outside the program.

If “No”, your child will not be allowed to leave the program until a parent or guardian has signed the daily log.

Who is allowed to pick up your child from camp other than the parents or guardians listed above?

 

1. Full Name
1. Full Name
First
Last
2. Full Name
2. Full Name
First
Last
3. Full Name
3. Full Name
First
Last
Exclusions: Is there anyone excluded from picking up this child?
1. Full Name
1. Full Name
First
Last
2. Full Name
2. Full Name
First
Last

Medical Information

In case of an Emergency, we will call 911.

Does your Child have any allergies, physical limitations, or dietary restrictions we should be aware of? 

Permissions

My child has permission to use personal electronic devices to contact parents and guardians only, and only with the Camp Staff’s permission. The use of cell phones for entertainment purposes is not allowed, and so during the program we will ask that these devices be stored with the students’ personal effects. Please note, Camp Staff is not responsible for lost, misplaced, stolen, or damaged electronics.
ACRA has my permission to add my E-mail address to our group E-mail to provide important updates about ACRA upcoming activities and schedules.
I give ACRA permission to photograph my child and to use these photographs or reproductions for promotional activities including ACRA owned websites and Facebook, brochures, flyers, newspapers articles and advertisements, displays, and reports. I waive the right of inspection or approval of such photographs or reproductions. I also release ACRA from all claims or demands that I may have or can have on account of the use or publication of the photographs or reproductions. I authorize ACRA to use the photographs and reproductions free of charge.

CAMP POLICIES

  • Participation Fees: All payments must be made in advance; there are no refunds.
    $25 
    registration fee is due with registration (administrative costs)
    $175 per weekly session: must be paid on Wednesday the week before the session begins. Extended hours are an additional $45 weekly. We do accept payment from The Resource Connection. Funds are available! Please, apply for a subsidy in advance at cel.trcac.org.
  • ACUSD provides breakfast, lunch and two snacks daily for each camper. ACRA will provide a personal water bottle for each camper but they can choose to bring their own. Energy drinks, hot or iced coffee, and soft drinks are not allowed.
  • Camp provides daily admission to the swimming pool.
  • The hours for Summer Fun Days are 8:00 am – 4:00 pm. Extended hours are 7:30 am – 5:30 pm. any participant who has not been picked up by 4 pm (regular hours) or by 5:30 pm (extended hours) will be charged an additional $25 to cover staff costs. Our camps start June 26th and July 28th, 2023. We will be closed Tuesday, July 4th.

Release of Liablity:

Release of Liability:
In consideration of myself and/or the minor being permitted by the Amador County Recreation Agency (ACRA) to participate in the above-described activity, I, the undersigned hereby waive, release and discharge in advance any and all claims for damages for personal injury, death, or property damage which I and/or said minor child may sustain or which may occur as a result of my and/or said child’s participation in said activity. This release is intended to discharge in advance ACRA, its officers, employees, volunteers, or agents from and against any and all liability arising out of or connected in any way with the participation of myself and/or the minor in said activity, even though that liability may arise out of active or passive negligence or carelessness on the part of ACRA, its officers, employees, volunteers, or agents.
I understand that the described activity may be of a hazardous nature and/or include physical and/or strenuous exercise or activity; that serious accidents occasionally occur during the above-described activity; and that the participants in the described activity occasionally sustain mortal or personal injuries and/or property damages as a consequence thereof. Knowing the risks involved, I agree to assume all risks of injury and to release and hold harmless ACRA, its officers, employees, volunteers, or agents who through active or passive negligence or carelessness might otherwise be liable to me and/or said minor child. It is further understood that this waiver, release and assumption of risk is to be binding on the heirs and assigns of said minor and/or myself, the undersigned.
I do hereby fully release ACRA and its officers, agents, and employees from any and all claims from injuries, damage, or loss which I, or any minor child may have or which may occur to my minor child on account of his/her/their being transported by automobile.
I further agree to indemnify and to hold ACRA, its officers, employees, volunteers, or agents free and harmless from any loss, liability, damage, cost or expense, including attorneys’ fees, associated with or arising from my and/or said minor’s participation in the described activity.
I certify that if I am signing on behalf of a minor child, I have custody or am the legal guardian of said minor by court order. I hereby give my consent that in the event said minor requires medical or surgical treatment while under the supervision of said ACRA’s recreation personnel in connection with the described activity, such supervisor may authorize treatment. I also agree to pay all medical, hospital, or other expenses which said minor may incur as a result of such treatment.
I have fully read this Waiver of Liability, Medical Release, and Indemnification Agreement, and fully understand its contents. I understand and agree that if I am signing this agreement on behalf of my minor child that I will be giving up the same rights for said minor as I would be giving up if I signed this document on my own behalf. I am aware that this is a release of liability and a contract between me and ACRA and I sign it at my own free will.

CODE OF CONDUCT

Student’s Full Name
Student's Full Name
First
Last
All participants have the right to participate in the ACRA Summer Youth Programs in a positive and safe environment, free from disruptions. Participants will be expected to exhibit appropriate conduct that does not infringe upon the rights of others or interfere with the policies of the program. They must conform to ACRA policies and rules, obey directions, and be respectful of leaders, volunteers and other participants.

Prohibited student conduct includes the following:

  • Disrespectful behavior, bullying, or cyberbullying of other participants, staff, or volunteers
  • Any other verbal, written, or physical conduct that causes or threatens violence or bodily harm
  • Conduct that disrupts the summer program environment
  • Hiding from staff or willfully staying out of staff’s sight
  • Willful defiance of staff or volunteers
  • Obscene acts or use of profane, vulgar, or abusive language
  • Possession, use, or being under the influence of tobacco, alcohol, or prohibited drugs
  • Use of cell phones, cameras, videos, voice recordings, or other personal electronics without permission
  • No participant can leave the ACRA sponsored activity without parental permission in writing. Should a participant choose to leave, he/she/they will not be allowed back into the program that day.
I have read the summer conduct policies and agree to comply by signing this contract.