23 Summer Camp Registration Form
  • Zilo's Summer Enrichment Camp 2023

  • 1. Activity Supervisors

    All staff have passed level 2 background screenings, have 5+ years teaching experience and are eager to work with each of the youth that enroll in our program. Specialty staff and visitors are all trained and equipped in their area of expertise!
  • 2. Transportation

    Participants are responsible for securing their own transportation to and from the program. Zilo will provide transportation to all scheduled field trips. Adult volunteers and chaperones will accompany the participants during activity times during camp.
  • 3. Requirements

    The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section above. IF YOUR CHILD IS ON AN IEP OR 504 PLAN, PLEASE INDICATE THAT TO THE PROGRAM DIRECTOR.
  • 4. Consent

    I hereby attest that I am (we are) the legal parent\guardian(s) of the above-named child and hereby consent to the child's participation in the activities described above. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities. Students can be released from camp at any time.
  • 5. Insurance

    I/We understand that ZILO does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.
  • 6. Emergencies

    If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to and authorize the above-named activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).
  • 8. Release and Identification

    I release and waive, and further agree to indemnify, hold harmless or reimburse ZILO, the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.
  • 9. Payments / Late Fee

    Participation in camp is $80 per student per week and all payments must be paid in full by the start of each week (Monday) to maintain enrollment. Students will not be accepted if accounts are not current, and a $10 late fee will be assessed. Late pickup will not be tolerated and a late fee of $10 will be charged after one minute and $1 per min thereafter to be paid at the time of pickup / before the child returns. All funds paid are non-refundable.
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  • 9. Emergency Contacts

    If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
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  • Date*
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