Scramble Camp Paperwork
  • Scramble Camp Paperwork

    Please fill out the following information below.
  • Health Declaration

    Please read the statement below.
  • Primary Contact Information

    Please fill out the information below.
  • Format: (000) 000-0000.
  • Emergency Contact Information

    The information below will be used in the case of an emergency or in the case where we can't reach the primary contact listed on this form.
  • Format: (000) 000-0000.
  • Pick-Up Authorization Form

    Please check all of the authorized person(s) who are allowed to pick up your child(ren). Each authorized person must be at least 18 years of age. The named children on this form will not be permitted to leave Scramble with anyone who is not listed below. Authorized individuals must pick up the child in person and may be requested to show identification to Scramble staff. Children will not be released to individuals who fail to provide acceptable identification upon request. Please note that children must be picked up by designated times. If an authorized adult is unable to be reached, Scramble will contact the local police department to ensure your child returns home safely.
  • Camper Information

    Please fill out the information for EACH child registered for camp. Information not provided will be required upon drop-off.
  • Camp Child #1

    Please fill out the information below.
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  • Camp Child #2

    Please fill out the information below.
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  • Camp Child #3

    Please fill out the information below.
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  • Camp Child #4

    Please fill out the information below.
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  • Policies and Procedures

    Please read the information below in it's entirety
  • REGISTRATION: Our camps have open registration throughout the summer; spaces are limited! Registrations will not be processed without payment. Registration payment is non-refundable and due with the first payment. You may change the week your child is enrolled depending on availability. Only registered and paid individuals may participate in camp activities. 

    MANDATORY PAPERWORK: All participants must have all camp paperwork returned to the Camp Administrator by their first day of the summer camp to ensure a smooth drop-off process. If proper paperwork has not been filled out, Scramble may deny entry upon arrival without a refund or until proper paperwork has been completed.

    CANCELLATION POLICY: Scramble reserves the right to cancel a Camp due to insufficient registration with full refunds and notification. No credits, refunds, or makeup for missed days, or times. If Scramble is contacted the week prior to the start of camp, we can change the arrival date on your registration. Scramble credits will be issued on a case-by-case basis, and can be used towards a future camp.

    DROP-OFF & PICK UP PROCESS: All participants must be checked in/out by a member of our staff when they are dropped off and picked up. Participants are NOT allowed to sign themselves in or out, regardless of age. A camp participant will not be released to someone who is not his/her parent/guardian, or who is not listed on the Authorized Pick-Up Release Form. All participants must drop-off camp children and are welcome to stay at Scramble if they are accompanied by an additional child not registered in the camp program. We want to ensure a distraction-free environment for all of our campers. Thank you in advance for your understanding.

    AFTERCARE POLICY: Possibility for aftercare will depend on business hours and feasibility. If the location in which you are attending camp offers this option, please note that all aftercare sign-ups shall be completed no later than the Friday PRIOR to the start of your camp. Last minute aftercare sign-ups will be considered, but are not guaranteed. Camp pick-up for both summer camp programs will be from 3:30-4pm. Scramble will charge a late fee for any campers not registered for aftercare who are not picked up by 4:10pm ($50 per child with an increase to $75 per child late fee charge at 4:30pm). If a camper is not picked up after the registered end time of aftercare (5pm), parents will be immediately contacted in addition to an automatic late penalty fee of $100. Your assistance in ensuring that all campers that are registered for aftercare in advance and are picked up by the designated time will streamline the departure process. We appreciate our camp families and your cooperation as we ensure that we are able to continue to offer a safe, fun, and appropriately supervised aftercare environment.

    CAMPER PARTICIPATION & BEHAVIOR POLICY: Participants must abide by all Scramble Summer Camp rules. Scramble reserves the right to remove a participant if that child poses a safety threat to staff members or other participants. All participants must be potty-trained: can independently use the bathroom. The camper and parent must understand that children attending Scramble camps must listen to all staff on the premises. If the child can't listen, then our staff can't ensure their safety while attending camp. Therefore, the understanding is that a camper must listen to ALL staff at Scramble or their parent will be contacted. If the parent can assure us that they will listen, then they are welcome back. If the parents can't assure us that they will listen, they may return when they are ready to listen to the instructions of our staff in order to ensure their safety. At Scramble, it is our top priority to maintain the safety of all our campers.

    SICK PARTICIPANT POLICY: Keeping a sick child home prevents the spread of illness in the camp community and allows the child an opportunity to rest and recover. If in doubt, please keep your child home an extra day. Please report these conditions to the Camp Administrator when they occur. A note from a health care provider is required for return to camp if a child is not in attendance for consecutive days (for any reason). This verifies that is safe for them to return to camp. Mildly sick participants can lie down in a designated quiet area in our facility. Scramble will determine if a participant is too sick to stay at camp and will call the parents/guardians to come pick up their sick child if needed. In the event of a serious illness or injury, if the parent/guardian cannot be reached in time, the child may be transported to nearest Hospital for immediate care and treatment. When you keep your child at home at the first sign of a communicable disease, you are protecting your sick child from other health problems. You are also protecting other children and staff from exposure to the disease. If your child becomes ill with a communicable disease, contact your doctor to determine proper care, and then notify the camp office. It is in the best interest of your child’s well-being to keep them home if they are in an infections state. A sick child cannot participate effectively in camp in a meaningful way.

    Fever - The child should remain at home with a fever greater than 99°. The child can return to camp after he/she has been fever-free for 24 hours (without fever-reducing medicine such as Tylenol or Motrin).

    Vomiting - If your child has vomited during the night, the child should not be sent to camp. The child can return to camp only after being symptom free for 24 hours. Diarrhea - If your child has had three or more watery stools in a 24-hour period, the child should be kept home. A child with diarrhea should stay at home and return to camp only after being symptom-free for 24 hours.

    Colds - A good rule of thumb is to keep a child home at the beginning of a cold…the most infectious time and when he/she feels the worst. Please keep your child at home if he/she is experiencing discomfort that would interfere with his/her ability to participate in camp (i.e. uncontrollable coughing, severe lack of energy). If your child experiences green nasal discharge that continues throughout the day, or a cough lasting longer than ten days, or is accompanied by fever or chills and is productive of discolored sputum, consult with your physician. Return to camp when the child does not have a persistent cough and feels well.

    Cough or congestion - The child should remain home if the cough or congestion interferes with breathing and/or if wheezing.

    Chicken pox - The child should stay home until there are no new spots and all old ones are scabbed over. Usually this requires child to stay home seven to ten days.

    Conjunctivitis (pink-eye) - Following a diagnosis of bacterial conjunctivitis, the child may return to camp 24 hours after antibiotic treatment is started. Campers with viral infection may return when eyes are clear.

    Coxsackievirus (Hand, Foot and Mouth Disease) - The child must stay home during the acute phase/stage of illness while fever or lesions exist.

    Lice - Head lice have become an increasingly serious problem in communities all over the country. Scramble Indoor Play is taking precautions which are necessary in order to minimize the risk of lice infestation among our campers and staff. The following are the steps that we will be taking at Scramble this summer. We will carefully check all staff members on the first day of camp. During the pre-camp Staff Training Program, counselors will be taught how to detect symptoms of head lice and will be advised to discourage the sharing of personal articles such as hats or hair ties. If we find lice or lice eggs (nits) on your child, she/he will be sent home and may not return until fully clear of lice or lice eggs (nits). Please partner with us by checking your child or having your child checked for lice. If lice are found before camp starts and your child has been recently treated, please notify us so that we can re-check.

    We entrust each parent to ensure the above policy is followed. This policy helps protect all summer camp participants and staff from sickness before it spreads, and enables us to maintain a healthy, happy community. Your help is greatly appreciated!

    EMERGENCY PREPARDNESS POLICY: A mock fire drill will be performed so all campers are familiar with procedure and exit strategies. In the event of an emergency, a senior member of our staff will blow a whistle signaling to other staff, guests and campers to evacuate the building. Staff will bring all campers to designated safe areas outside the building while the problem is resolved.

    STAFF REQUIREMENTS: Senior staff receive CPR and First Aid training, but are not certified. Additionally, all our staff undergo first aid and bloodborne pathogen awareness training.

    FOOD ALLERGIES & SAFETY: We are pleased to be able to provide lunch, drinks and snacks as part of our camp program. Our food is prepared fresh daily by our own staff in Scramble. Lunch includes a choice of sandwich (ham and cheese,
    turkey and cheese, PBJ or grilled cheese), a side (chips or sliced apples) and a drink (water or Honest juice carton). In addition, we will provide morning and afternoon snack to include a variety of options such as goldfish and applesauce. Each camper will receive their own water on arrival (you may send them with their favorite water bottle if you wish) and we will hand out more water throughout the day. Scramble is allergen aware and we can make some of our items in a such way that they will limit exposure to some allergens. It is not possible, unfortunately, for us to make allergen free items as many products we receive come from sources where cross-contamination might occur, and Scramble itself is not allergen free: allergens may be introduced by other campers or other guests.
     
    If you are concerned about allergens, please contact us so that we can discuss how to keep your camper safe at Scramble.  This may mean that you will need to provide your own lunch and snack items, though we will do all that we reasonably can to accommodate your requests.  It may also be the case that potential allergens at Scramble may present an unavoidable hazard to your camper.  In such circumstances, and where allergen reactions might be severe, we would ask you to carefully consider if Scramble is the right environment for your camper.  While our staff are trained in emergency procedures, we are not able to administer medicine and will be obliged to call you or emergency services for any situation beyond our control.

     
    If you provide allergen information about your camper, this information will be stored by us for the duration of the camp and only shared with our staff involved in providing camp, food, or safety services.  We will review training with staff at the beginning of the camp week and prior to each camp day.

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  • Waiver

    Please read the information below in it's entirety
  • PLAYOPOLIS LLC d/b/a SCRAMBLE

    PARTICIPANT AGREEMENT, ASSUMPTION OF RISK,RELEASE OF CLAIMS, AND WAIVER OF LIABILITY

    (PLEASE READ THIS FORM COMPLETELY AND CAREFULLY)

    I, the undersigned, wish for my minor child to participate in the activities, events, and programs offered by and through Playopolis LLC d/b/a Scramble and its owners, members, officers, employees, volunteers, agents and all other individuals and entities acting in any capacity on its behalf (collectively referred to as “Scramble”). I understand that all individuals wishing to participate in a Scramble activity, event or program are required to review and submit a completed Participant Agreement, Assumption of Risk, Release of Claims, and Waiver of Liability (the “Agreement”). I acknowledge that I have read the rules (the "Rules") governing my child’s participation, and the participation of those under my supervision, in Scramble activities, events, and programs, and that I have explained the Rules to those under my supervision. I acknowledge that failure to follow the rules could result in the expulsion of myself and those under my supervision. I certify that my child is physically able to participate in Scramble activities, events, and programs without aid or assistance.

    I understand and acknowledge that Scramble activities, events, and programs for my child will involve use of Scramble’s premises and facilities, including, but not limited to its: play space; recreational equipment and structures; sports courts; food service area; changing, waiting and related areas, and may involve, strenuous physical exertion, physical impacts, and activities off the ground that are inherently high risk.

    I acknowledge that I am entering into this waiver and release of liability knowingly and voluntarily on behalf of my child. I hereby assume, on behalf of my child, myself, and my spouse, heirs, assigns personal representatives, estate, insurers, and any individual for whom I have legal responsibility, all risks associated with my child’s participation in Scramble activities, events, and programs. I fully acknowledge and recognize that risks may be involved in Scramble activities, events, and programs, and that such risks may include physical or psychological injury, including but not limited to illness, disease, paralysis, death, damages, economic or emotional loss, that my child may suffer as a direct or indirect result of my child’s participation in the Scramble activities, events, and programs, including travel to and from such activities, events, and programs.

    I expressly agree, in consideration of my child being permitted to participate in Scramble activities, events, and programs, that I fully accept and assume all such risks and all responsibility for losses, costs, or damages incurred by my child that may be caused by my child’s own actions or inaction or the actions or inaction of others participating in Scramble activities, events, and programs. I represent that my child is physically able to undertake any and all such activities, events and programs. If, at any time, I believe conditions to be unsafe, I will immediately discontinue my child’s participation in the Scramble activity, event, or program.

    I on behalf of my child further agree to release Scramble and its owners, members, officers, employees, volunteers, agents and all other individuals and entities acting in any capacity on its behalf Scramble (collectively “Scramble”), and hold harmless and indemnify Scramble from all damages, claims and liability, including expenses, costs and attorneys’ fees, as a result of my child’s voluntary participation in Scramble activities, events, and programs, to the extent that those claims and liability are caused by my or my child’s own negligence or willful misconduct, or are caused by the negligence or willful misconduct of others participating in the activities, events, and programs, to the fullest extent allowable by law. I further agree that Scramble assumes no responsibility for the welfare of my child’s property or belongings in this sport or activity. I understand that Scramble does not provide health insurance for individuals participating in Scramble activities, events and programs. As such, my child’s personal health insurance will be responsible for payment of medical services and care for any injuries sustained by my child during a Scramble activity, event or program. In the event that my child requires medical attention relating to my child’s participation in a Scramble activity, event, or program, I understand that all reasonable attempts will be made to contact my designated emergency contact, at the emergency number(s) I have provided. If contact with my designated emergency contact is not reasonably possible, I authorize qualified emergency care personnel to hospitalize, secure treatment for, and take whatever medical action(s) are necessary to treat my child. I further authorize Scramble to contact my designated emergency contact about my child’s physical or mental health during the activity, event, or program, if Scramble deems it advisable to do so.I on behalf of my child authorize Scramble to record and publish all photographs and videos in which my child appears or speaks that are taken by or for Scramble (“Recordings”). I agree that Scramble may use, reproduce, publish, perform or distribute these Recordings, for any purpose, including promotional and advertising use, alone or in combination with other recordings, in all media (print and electronic). Recordings may be edited, e.g. to conform to space and time requirements, applicable laws and regulations, telecast and publishing policies, and to insert commercials and other announcements. This right and permission includes, but is not limited to, use of my child’s name, voice, photograph or likeness, and biographical information, to the extent permitted by law. I on behalf of my child release all claims against Scramble and others with respect to the copyright, publication, or use of such photographs or videos, including any claim for compensation related to the use of the Recordings permitted herein.

    Any dispute or controversy between the parties hereto arising out of or relating to this Agreement, the use of Scrambles facilities, or participation in Scrambles activities, events, and programs, shall be governed by the laws of the Commonwealth of Virginia, without regard to its conflict of law rules, and shall be resolved in a court of competent jurisdiction in the City of Alexandria, Virginia. I HEREBY FURTHER AGREE TO WAIVE MY RIGHT TO TRIAL BY JURY. I agree and understand that this agreement is intended to be as broad and as inclusive as permitted by Virginia law and if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect. I understand and affirm that there are no other representations, warranties, promises, or understandings, written or oral, regarding the subject matter of this Agreement, and that I will bound by the terms of this Agreement. I have had reasonable and sufficient opportunity to read and understand this entire document and consult with legal counsel, or have voluntarily waived my right to do so. I knowingly and voluntarily agree to be bound by all of the terms and conditions set forth herein. I represent that I have the actual authority to and do hereby enter into this agreement on behalf of, and as an authorized agent of, the parents of any minor on whose behalf I am signing this Agreement, or as the parent or legal guardian of any child(ren)/ward(s) listed on this Agreement. I have read and knowingly and voluntarily have signed this agreement and specifically the release contained herein and further agree that no oral representations, statements or inducements have been made to me.

    I acknowledge that I have read this document carefully and fully understand its contents. I agree that, should any provision or aspect of this Agreement be found to be unenforceable, that all remaining provisions of the Agreement will remain in full force and effect.

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