Harbor Point Association Day Camp Registration

Camper 1

First Last

Date of Birth

Current Age

Camper 2

First Last

Date of Birth

Current Age

Camper 3

First Last

Date of Birth

Current Age

Parent(s)

Responsible Party

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Local Phone

Cell Phone

Email

Enter Email Confirm Email

HARBOR POINT COTTAGE No.

Put NR for Non Resident

Number*

HARBOR POINT SPONSOR

Name

First Last

Phone*

AVAILABLE DATES

Your Child Must Be Registered One Week before the Monday start date

Untitled*

Week 1, June 24 – June 28
Week 2, July 1 – July 5 (No Camp July 4th)
Week 3, July 8 – July 12
Week 4, July 15 – July 19
Week 5, July 22 – July 26
Week 6, July 29 – August 2
Week 7, August 5 – August 9

MEDICAL INFORMATION

DOES CAMPER HAVE ALLERGIES?

Yes
No

LIST ANY OTHER MEDICAL PROBLEMS THAT MAY AFFECT CAMPERS ABILITY TO PARTICIPATE IN CAMP ACTIVITIES

EMERGENCY CONTACT (OTHER THAN PARENTS)

Name

First Last

Phone

DROP OFF AND PICK-UP PLAN (SEE PERMISSION FORM)

OTHER ADULTS WHO MAY PICK-UP/DROP OFF MY CHILD:

Parent/Guardian Permissions for Harbor Point Association (Day Camp Program)

Name of Child 1

First Last

Name of Child 2

First Last

Name of Child 3

First Last

*

I give permission for counselors to take steps needed for administering first aid/CPR and for obtaining emergency medical care for injuries or suspected injuries. In an emergency, a counselor will call the Harbor Point Office and the office staff will contact the local ambulance service. The parent cell phone number(s) will be called first, then the emergency phone number listed.

*

I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child

Please note the ‘drop off’ and ‘pick up’ daily arrangements for your child. Parents or an authorized adult must check-in and check-out their children to camp every day by signing the attendance list at the Registration booth. For their personal safety, children are not allowed to be dropped off, or check themselves in or out. If you would like to pick up your child before normal dismissal time, please inform the Camp Director or Camp Manager. I agree to adhere to these ‘drop off’ and ‘pick up’ arrangements. My child is over 8 years of age.

I give my permission for the Day Camp program to post my children's unidentified photo on the Camp Website/Newsletter.

The following arrangements will be in place for my child

*

I acknowledge my child will be on Appropriate Behavior at all times and is identified as but not limited to:

Following directions.
Keeping their hands, feet, mouths and objects to themselves.
They will stay with their group/counselors at all times.
Will use materials, supplies and equipment properly and as instructed.
Will treat counselors, staff and other campers with respect.
Will never use foul language, tease or bully others.

A child may be removed from Camp at our Director’s discretion.

I, the undersigned, individually and as parent/guardian of the minor herein above identified, assume all responsibility for and all risk of damage or injury that may occur to the minor herein below identified as a participant in the Harbor Point Association (Day Camp Program), while attending sessions or using equipment or facilities of said Program including water activities and activities that are part of the said program that take place off of the Harbor Point Association grounds that will require bike riding, walking or bus transportation to said activity. I also understand that this will include said minor(s) participation in clinics and workshops under the leadership of organizations other than the Harbor Point Association (Day Camp Program). In consideration of the acceptance of the minor(s) herein above named as participant in the Harbor Point Association (Day Camp Program), the undersigned hereby releases and discharges the Harbor Point Association, its shareholders and members, employees and agents from all claims, demands, rights, or causes of action, present or future, whether known, anticipated or unanticipated, and resulting from or arising out of, or incident to, participation of the minor(s) herein above identified in the Harbor Point Association (Day Camp Program).

Parent / Guardian Signature*

Parent/Guardian Name

First Last

Date

Signature of Witness

Phone

This field is for validation purposes and should be left unchanged.