2025 Summer Camp Registration

2025 Camp L.I.F.E. Summer Camps

REGISTRATION CLOSED FOR 2025 SUMMER CAMPS!! Classes start June 17th! Visit www.ys4cpm.com today! Available for grades 1st - 12th. (Day Programming 9am-1pm)
Camper's First and Last Name *
Camper's Nickname*
T-Shirt Size*
Camper's Phone Number*
Birthdate*

MonthDayYear
Date
Grade*
Parent(s)/Guardian(s) Name*
Example: Mother, Father, Grandmother, etc.
Home Phone
Work Phone
Cell Phone*
Hugo Housing Authority Resident*

YesNoOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The information contained herein is for CONFIDENTIAL USE ONLY.
THINGS MY CHILD DOES WELL
MY CHILD HAS DIFFICULTY WITH THESE ACTIVITIES
WHAT MY CHILD LIKES AND DISLIKES
Client Transportation Policy
YS4CPM makes no guarantee or promise of vehicular transportation as part of it programs. When YS4CPM voluntarily makes such transportation available our goal is to provide this in a professional and safe manner.

Parent and Guardian of Youth

Please be aware that YS4CPM staff alone determine if and when vehicle transportation will be provided for our programs. YS4CPM makes no guarantee of vehicle transportation and such transportation may be unavailable on short note due to vehicle shortage, mechanical failure, qualified driver shortage, insufficient staffing and volunteers, or otherwise.

Field Trips

YS4CPM may arrange for vehicle transportation for field trips outside of a distance from YS4CPM facilities. Permission slips are required for these field trips, your signature authorizes all transportation in association with that summer camp or field trip .

Media Release

I grant permission to Youth Services for Choctaw, Pushmataha, McCurtain Counties and Goodland Academy, its agents and assigns, to use my photo or video, and likeness for the purpose of promotion by YS4CPM and community partners for all forms, media and manners, for the following, but not limited to, news releases, photographs, video, audio, website, marketing, advertising, trade, promotion, exhibition for an indefinite period of time. I give unrestricted permission for images, videos, and recordings of myself to be used in print, video, digital and internet media. I agree that these images and/or voice recordings may beused for a variety of purposes and that these images may be used without further notifying me. I further acknowledge that I will not be compensated for these uses and YS4CPM and Goodland Academy owns all rights to the images, videos, and recordings, and to any derivative works created from them. I waive any right to inspect the uses of any printed or electronic copy. I hereby release YS4CPM and Goodland Academy and its agents and assigns from any claims that may arise from these uses, including without limitation claims of defamation or invasion of privacy, or of infringement of moral rights or rights of publicity or copyright. This release expresses the complete understanding of the parties.

Liability Release

By signing this form, I hereby release YS4CPM and community partners, any affiliates, volunteers, and any other entity connected with the facilitation or representation of YS4CPM and community partners for any and all known or unknown damages, injuries, losses, and/or claims, that may be suffered by participant or his/her property during the participation of the said activity/program/event.
I Agree*
Transportation Authorization
I give Youth Services for Choctaw, Pushmataha and McCurtain Counties permission to transport my child/ren in agency owned vehicles (including third party community partners) to and from all activities and field trips, between all Youth Services for Choctaw, Pushmataha and McCurtain Counties Services. .

Your electronic agreement on this blanket permission slip allows your child/ren to attend scheduled summer camps, field trips, events with Youth Services for Choctaw, Pushmataha and McCurtain Counties Services at various camp locations which the child/ren are registered.

In case of emergency such as a natural disaster or national emergency, your signature on this blanket permission slip allows your child/ren Services, to be transported by agency owned vehicle, First Responders or Youth Services for Choctaw, Pushmataha and McCurtainCounties Inc. staff owned vehicle to the nearest disaster relief shelter. Youth Services for Choctaw, Pushmataha and McCurtain Counties Services will notify parent(s)/guardian(s) of children's emergency location via telephone call. The emergency telephone number(s) we use to contact parents/guardians are listed on the child's emergency form.

I understand that all necessary precautions will be taken by Youth Services for Choctaw, Pushmataha and McCurtain Counties Services for the safety of my child/ren.
Reminder: Children are required to wear appropriate clothing as well as appropriate shoes. Thank you.
I Agree*
Camper Health History
Camper's Name
Birthdate

MonthDayYear
Date
1st Emergency Contact (Parent or Legal Guardian)*
1st Emergency Phone Number*
2nd Emergency Contact (Other than Parent or Legal Guardian above)*
2nd Emergency Phone Number*
Camper's Physician*
Physician Phone *
1. Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?
YES, Explain:
NO
2. Are there any medications, dietary restrictions, allergies, or special needs/procedures we need to be aware of to ensure that your child’s camp experience is positive? Signs/symptoms to look for? Current medications?
YES, Explain:
NO
Who can pick participant up (if applicable)?
Name*
Contact *
Name*
Contact*
Name
Contact
Name
Contact
Safety Rules and Guidelines
We will monitor, change, and plan activities according to CDC guidelines and state policies. To provide a safe camp environment for participants, guest, and staff the following health and safety guidelines will be:

Any camper(s) exposed to COVID, experiencing symptoms, or that have traveled abroad is asked to quarantine and take necessary precautions before attending camps.

o Guardians will be contacted for campers with temps exceeding health standards. Campers will be allowed to participate in camp once temperature is within health standards.

o Sanitation before, during, and after class will be provided.
I Agree
Camp Schedule & Locations

Camp Schedule will be available after submission.
Announcements ( via Remind 101 Text Messaging)

📱For updates and announcements, please accept the invite to our group chat via Remind 101 Text Message Service or join our group by chat here *by text, app, and or email): https://www.remind.com/join/ys4cpmcamp P.S. If you have any questions, contact the Youth Services Office tomorrow at 580-326-3382 or stop by the new location 410 South F Street, Hugo, OK 74743 !
Submission of application required to receive camp calendar, locations and details.
Should be Empty:

2025 Camp L.I.F.E. Summer Camps

The information contained herein is for CONFIDENTIAL USE ONLY.

Client Transportation Policy

Transportation Authorization

Camper Health History

Safety Rules and Guidelines

Camp Schedule & Locations

Announcements ( via Remind 101 Text Messaging)