Roseville Summer Day Camp Registration

Parent/Guardian Information

Emergency Information

Photo Release

I, {Guardian} hereby irrevocably grant to The Roseville Salvation Army the absolute right and permission to copyright and/or publish or use photographic portraits, pictures or video of my child in which my child may be included in whole or in part, or composite or distorted in character or form, in conjunction with his/her name or a fictitious name, or reproductions thereof in color or otherwise, made through any media, for art, advertising, or any other lawful purpose whatsoever. I also grant The Roseville Salvation Army the same right and permission to use any statements or testimonials made by myself or my child.

Medical Release and Authorization

 I, {Guardian} grant The Roseville Salvation Army, acting through any adult representation thereof, into whose care the said minor has been entrusted: to consent, upon the advice of a physician and surgeon licensed  under the provisions of the state Medical Practice Act, to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision of a physician; and to consent, upon the advice of a dentist licensed under the provisions of the Dental Practice Act, to an x-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision of a dentist.

In case of minor injury or illness (bruises, headaches, stomachaches, minor cuts, etc) I wish that my child be held at The Roseville Salvation Army facility.  Notification will not be made for minor injuries or illnesses unless the participant requests it or in case of in excess. 

In case of serious illness (cut requiring stitches, head injury, broken bones, etc.) I wish that my child be sent to a hospital and/or that skilled medical aid be contacted at once, for which I expect to pay the usual charge.  I wish for The Roseville Salvation Army staff to make every attempt to contact me at once for any injury requiring hospitalization or serious medical attention.

I give my permission for my child to attend the above checked program.  I will not hold The Roseville Salvation Army responsible for any accidents that may occur at the facility or to and from the facility.

Activity Consent:

The program offers a wide variety of activities for participants to challenge themselves in skill/confidence/teamwork building as they choose.  All reasonable precautions for health & safety are taken, and participation in all program activities is at the participant’s own risk.  The programs activities may include, but are not limited to: running / jogging, jumping, climbing, general court/field games, relays, etc. 

Participant Agreement

 If allowed to attend the above checked program, I promise to abide by the program rules and I will cooperate with staff and volunteer leaders. I believe that cooperation between participants and staff is necessary for a successful program.

Campus Rules

The following rules are provided to ensure order and safety for all program participants and staff members. The Roseville Salvation Army reserves the right to dismiss any person (youth or adult) whose conduct is unacceptable, or who shows a lack of respect for persons or property. In case of dismissal, program fees will not be refunded.

·         Participants are expected to display respectful and courteous behavior towards staff members and volunteers. This includes listening to staff when they are talking, giving instructions, or leading a group.

·         Participants must keep their hands and feet to themselves.  They may not hit, bite, kick, slap, punch, or throw objects at other participants, staff, or volunteers.

·         Swearing, inapproripate conversation of a sexual nature or other inappropriate conduct will not be tolerated.

·         Fighting, taunting, or verbal threats will result in immediate dismissal from programs.

·         Participants must treat each another with respect and love.  Name calling, teasing, and any type of bullying – including bystander bullying -- will not be tolerated.

·         Alcoholic beverages, illegal drugs, smoking, or chewing tobacco is not allowed on the property.

·         Weapons of any kind, real or fake, are not allowed in or around the property.

·         Clothing and shoes must be appropriate for the activity.

o  Skirts and shorts must be fingertip length.

o  Shirts may not have inappropriate sayings (Ex: Bootylicius, Hottie, Sexy, etc.) or symbols (Skulls, crossbones, demons, devils, gang figures, etc.).

o  Sagging is not allowed, nor is any clothing or accessory considered to be gang related.Opened toed shoes are NOT allowed.

o  Gynamisum participants must have soft sole, non-marking shoes when on the gynmasium floor. NO EXCEPTIONS

o  Swimsuits: In the event of water games or field trip to a pool, swimsuits swimsuits must be 1 piece for girls.

·         No cell phones, music players, or gaming devices are permitted to be used during the program.

·         No personal toys or sports equipment allowed, unless given written permission by the Director

·         No outside food or drink (including chewing gum and candy) will be permitted.

·         The respect and care of center property and vehicles is very important.  There is to be no destruction or vandalizing of the center’s property or vehicles.  Horseplay, wrestling, running, and climbing trees, walls of fences are not permitted.  Seat belts must be worn in all vehicles and participants must sit facing forward with both feet on the floor.

·         The Roseville Salvation Army is not responsible for any clothes, swimsuits, towels, or any other personal item that the participant brings with them.

** Rules will be added, edited, or changed at the discretion of The Roseville Salvation Army Staff.

Discipline Policy

·         In most cases, each participant will receive a warning if they are doing something inappropriate.  After a warning is issued if the participant continues the inappropriate behavior he/she will be written up and receive time out (depending on the severity of the action)

·         The second time the participant is written up for inappropriate behavior, he/she will again lose privileges and parent will be notified of behavior.

·         The third time the participant is written up for inappropriate behavior will result in the participant being suspended from the program for 1 week and again the parent will be notified of the behavior.

·         The fourth time a participant is written up for inappropriate behavior, he/she will be dismissed from the program without a refund.

·         If your participant(s) is dismissed from the program you will need to have him/her picked up within ½ hour (30 minutes)

** Disciplinary actions could change depending upon the severity of the inappropriate behavior.

Permission To Travel

I give my permission for my child to travel with The Roseville Salvation Army Programs for all field trips.

As a parent or legal guardian, I approve of his/her joining and participating in the activities of The Roseville Salvation Army Programs and agree not hold The Salvation Army or its staff and volunteers responsible or liable.  I hereby release them from liability for losses of any personal injuries or accidents suffered by my child while participating in any Roseville Salvation Army programs or functions.

Child Pick Up Policy

The first time your participant(s) is picked up late you will receive a verbal warning.  The second time your participant(s) is picked up late you will be charged $2.00 for every minuteYour child will not be able to attend the program until the late fee is paid in full. Excessive tardiness will not be tolerated and could result in dismissal from the program. In the event you are later than 30 minutes we have the right to contact the local authorities.  This policy is for the protection of the participant(s) and not to inconvienence the parents.  Please make sure that you pick up your participant(s) on time and have correct telephone numbers and emergency contact information in your child’s file.

Transportation Contract

 

Parents please review the Transportation Contract with your child.

 

Passenger Conduct

 

1. Respect your driver and follow all Instructions.

2. Stay in your seat at all times.

3. Keep all parts of your body inside the bus/vehicle.

4. No loud, disruptive behavior including offensive/vulgar language and fighting.

5. Do not throw object on or out of the bus/vehicle.

6. Place trash in designated areas, and do not leave items in the bus/vehicle.

 

 Consequences of Unacceptable Behavior

 

1. Verbal warning.

2. Possible referral.

3. Field Trip privileges suspended. 

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. I AM SIGNING IN AGREEMENT WITH ALL THE ABOVE STATEMENTS.