Registration

Child

MM slash DD slash YYYY
Address

Parent/Guardian – Contact Information

Parent/Guardian #1

Address

Parent/Guardian #2

Address

Emergency Contact Information – Alternate Pickup/Release

Emergency Contact #1

Emergency Contact #2

Please list those people including in addition to parents/guardians who are permitted to pick up your child:

Medical Information

Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures allergies).

Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?

Is your child allergic to any type of food or medication?

Does your child require a special diet?

The purpose of the above-listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.

Deposit:

$250 deposit is due at the time of camp registration. This deposit will be put towards camp tuition.

SUMMER CAMP TUITION & PAYMENT:

Summer camp tuition fee is due on every Monday the week that your child is enrolled, either by cash or credit card. If a camper’s tuition is not paid they will not be able to attend camp. Please note that we do charge for holidays, sick days and any absent days. Payment will be require in full including holidays if any in that week, sick days or absent days.

Please select from the following payment options:
The financially responsible party signing this form understands and agrees to follow the Tuition Payment and Fees Policy.
Payments are Secured by Stripe
Assumption of Risk
Assumption of Risk

July 2023

Sun Mon Tue Wed Thu Fri Sat
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31

July 27, 2023

July 28, 2023

July 29, 2023

July 30, 2023

July 31, 2023

LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Child
Parent/Guardian - Contact Information
Parent/Guardian #1
Parent/Guardian #2
Emergency Contact Information – Alternate Pickup/Release
Emergency Contact #1
Emergency Contact #2
Please list those people including in addition to parents/guardians who are permitted to pick up your child:
Medical Information
Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures allergies).
Medical Problem
Required Treatment
Should paramedic be called?
Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
Is your child allergic to any type of food or medication?
Does your child require a special diet?
The purpose of the above-listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
Deposit:
$250 deposit is due at the time of camp registration. This deposit will be put towards camp tuition.
SUMMER CAMP TUITION & PAYMENT:
Summer camp tuition fee is due on every Monday the week that your child is enrolled, either by cash or credit card. If a camper’s tuition is not paid they will not be able to attend camp. Please note that we do charge for holidays, sick days and any absent days. Payment will be require in full including holidays if any in that week, sick days or absent days.
The financially responsible party signing this form understands and agrees to follow the Tuition Payment and Fees Policy.
Terms of Agreement
Photo Release
I hereby give permission for my child to be photographed during the LetsPlay Summer Camp. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports and for promotional purposes including flyers, brochures, newspapers and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Feather Lets Play Summer Camp
LetsPlay and its organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred. Photos and quotes may be used for publicity purposes.
LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Participation Consent Form
(REQUIRED)
I, the undersigned*, herby release discharge, indemnify, hold harmless and defend LetsPlay its employees and volunteers from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against LetsPlay due to death, personal injury or illness, loss or damage to property, or future causes that occur during the LetsPlay Summer Camp. In the event of any medical emergency, I authorize and consent to LetsPlay to act on behalf of the medical care deemed necessary for the participant.
LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Assumption of Risk

I understand and acknowledge that the Summer Camp Program involves outdoor, wilderness travel and may include (but shall not be limited to) the following activities: walking, running, playground and splash pad activities. I understand that my child(ren) may engage in activities not listed above. I am aware that participation in the Summer Camp program involves risks to personal safety and physical risks, which can range from (but are not limited to) minor injuries such as scratches, bruises, and sprains to catastrophic injuries, including paralysis and death. Some, but not all of the risks I may encounter include: extreme or inclement weather (including thunder and lightning), physical contact with other participants or individuals; or misjudgment by the LetsPlay leaders, volunteers, other staff or contractors; local flora and fauna, and risk of infection/disease. I am voluntarily participating my child(ren) at the Program with knowledge of, and hereby accept and assume the risks, dangers and hazards involved, including responsibility for any losses, costs and damages arising out of such risks, dangers, and hazards.
I understand that LetsPlay owns and operates a privately owned bus for private transportation to and from various activities. I understand that allowing my child(ren) to participate in these activities carries a certain amount of risk. I hereby release and hold harmless LetsPlay, their owners, employees, volunteers, agents, and insurers, and any and all cooperating institutions and their officers, agents, employees and insurers (collectively, the “Releasees”) from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, in any way associated with my participation in the Program. I understand that this Waiver discharges the Releasees from any liability or claim that I may have against the Releasees with respect to bodily injury, personal injury, illness, death, or property damage that may result from my participation in the Summer Camp Program and busing transportation.