2022 Club at Cheval Summer Camp Registration Form

Camp Cheval Camper Registration

Thank you for joining us for Cheval Summer Camp 2022! Please allow us 2-3 business days to process your registration and payment. As a reminder, in order to reserve your child’s camps, their first week of camp must be paid in full, and all remaining weeks of camp each require a $25 deposit. Weekly camp information, including drop off, pick up and field trips will be sent out on the Thursday prior to the week of your child’s camp. We look forward to seeing you and having a wonderful summer. If you have any further questions, please reach out to Ashley Killoran at akilloran@playcheval.com.
Camper(s) Information

Up to four campers (with the same contact information) can be on one registration form
Number of campers to be registered: *

**THIS FORM IS FOR NEW CAMP REGISTRATIONS**

If you would like to update, delete, change, etc. an existing registration, please click HERE.

To access the 2022 Credit Card Authorization Form, please click HERE.
Camper 1 Name *

First Name Last Name
Camper 1 Birth Date *

Month Day Year
Camper 1 Grade (entering) *
Known Medical Concerns

Please list any allergies, chronic illness, or medical conditions for each camper. Please describe in detail to ensure proper care is given to your camper.

If there are no known medical concerns, please type "N/A" to advance in the regsitration process.
Please list medical concerns: *
Camper 1 Gender *

Male Female
Camper 2 Name *

First Name Last Name
Camper 2 Birth Date *

Month Day Year
Camper 2 Grade (entering) *
Known Medical Concerns

Please list any allergies, chronic illness, or medical conditions for each camper. Please describe in detail to ensure proper care is given to your camper.

If there are no known medical concerns, please type "N/A" to advance in the regsitration process.
Please list medical concerns: *
Camper 2 Gender *

Male Female
Camper 3 Name *

First Name Last Name
Camper 3 Birth Date *

Month Day Year
Camper 3 Grade (entering) *
Known Medical Concerns

Please list any allergies, chronic illness, or medical conditions for each camper. Please describe in detail to ensure proper care is given to your camper.

If there are no known medical concerns, please type "N/A" to advance in the regsitration process.
Please list medical concerns: *
Camper 3 Gender *

Male Female
Camper 4 Name *

First Name Last Name
Camper 4 Birth Date *

Month Day Year
Camper 4 Grade (entering) *
Known Medical Concerns

Please list any allergies, chronic illness, or medical conditions for each camper. Please describe in detail to ensure proper care is given to your camper.

If there are no known medical concerns, please type "N/A" to advance in the regsitration process.
Please list medical concerns: *
Camper 4 Gender *

Male Female

Camper's Address
Address *

Street Address

Street Address Line 2

City State

Zip Code
Parent/Guardian Information
Contact 1 *

First Name Last Name
Relationship to Camper *
Cell Number *
E-mail *
Contact 2

First Name Last Name
Relationship to Camper
Cell Number
E-mail
Authorized Pick Up List

Please list those authorized, other than the parents listed above, to pick up your camper(s).
I would like to list others who are authorized to pick up my camper(s). *
Name *

First Name Last Name
Cell Number *
Name

First Name Last Name
Phone Number
Name

First Name Last Name
Phone Number
Emergency Contact Information

In an emergency, the parents listed above will be contacted first. Therefore, please provide other local contacts we can call. Thank you.
Emergency Contact *

First Name Last Name
Relationship to Camper *
Phone Number *
Emergency Contact *

First Name Last Name
Relationship to Camper *
Phone Number *

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Club at Cheval during the selected camp. In exchange for the acceptance of said child’s candidacy by The Club at Cheval, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Club at Cheval and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In a case of injury to said child, I hereby waive all claims against The Club at Cheval; including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all camp activities. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.
I have read and agree to the above: *

Yes
Medication

If your child takes any medication, you must bring in the medication and we will have you complete a form informing staff of the medicine(s) your child needs to take. A doctor's prescription is required for our staff to oversee administration of any medication (including over the counter medication).

Medications will be kept on a weekly basis only and must be stored in their original container. A photo of your child must accompany the medicine and form. Anytime your child needs any medicine(s) during the program, you will need to bring the medication to the camp director and fill out a medication form.

This form will include the following information below: 1. Name of medicine(s). 2. Time(s) that the child is to receive the medication(s). 3. Dosage amount for each time provided. 4. Signature and date of a parent or guardian.

.
I have read and agree to the above: *

Yes
COVID STATEMENT

We will determine which of the below safety protocols to continue for our Camp Cheval 2022, based on recommendations from the CDC and local health officials. We will be sure to communicate the safety guidelines we will implement prior to the start of summer camp.

Our current protocols are as follows:

1. Children are assigned to their grade level and groups are evaluated throughout the summer.

2. Each group will be assigned a designated room during inside activities.

3. Ample access to hand washing and hand sanitizer stations are available.

4. Cheval staff intentionally teach and encourage good hand hygiene, respiratory etiquette, and follow a strict sick child/staff policy.

5. Additional cleaning and sanitizing procedures will take place daily.

.
I have read and agree to the above: *

Yes
Photo/Video Release

I grant full permission to The Club at Cheval to use photographs and videos of my child(ren) for publication in print and/or social media.
Please choose the response that applies: *
Transportation Release

I give my child(ren) permission to be transported by The Club at Cheval staff on field trips.
I have read and agree to the above: *

Yes No
Emergencies

Camp Cheval staff will treat routine cuts, scrapes, and bumps. If the injury is more serious, we will take immediate steps to secure medical treatment while contacting you or the contacts listed on the program registration. Your signed authorization on the program registration allows us to provide prompt treatment.
I have read and agree to the above: *

Yes
Illness

Camp Cheval cannot provide care for sick children. If a child has any sign of illness or fever, the parent will be called to pick up the child. If a child has no overt symptoms of illness, but displays significant behavior changes and is clearly uncomfortable, a parent will be called to pick up the child. If a parent cannot be reached, the staff will call the emergency contacts in the order they are listed. There are no refunds for days missed due to illness.
I have read and agree to the above: *

Yes
Access to the Cheval Community

We are fortunate to hold camp, securely, behind the gates of Cheval. To ensure traffic flows as best as possible, we suggest the following:
- There are three entrances/exits to the Cheval community: Dale Mabry Highway, Lutz Lake Fern Road, & Ramblewood Road.
- During the morning hours of 8am - 9am, traffic exiting the community is heavy at the Dale Mabry gate. Therefore, please plan accordingly and/or utilize the other two gates when possible.
- Please make sure you have your camper pick up card visible when going through the gate, as this will expedite the process.
I have read and agree to the above: *

Yes

Camp Cheval Payment Procedures
- At the time of registration, the first week of camp for each camper must be paid in full and a $25 deposit for each week of camp after. All payments are non refundable and non transferable, with no exceptions.
- To be officially registered, with a spot reserved, payment must be received.
- A credit card must be kept on file for all weekly charges.
- All payments will be in the form of credit cards or checks. If paying by check, please submit payment before close of business the Tuesday prior to the start of camp so that your child's reservation isn't forfeited.
- If you choose to pay via credit card, there will be a 3% convenience fee added to the total. All credit card payments will take place the Wednesday prior to the start of camp.
- All checks will be processed by 5 pm the Tuesday prior to camp starting, or the credit card on file will be charged with the 3% convenience fee added to the total.
- There is a $25 fee associated with declined credit cards and/or returned checks.
- All camp cancellations must be received by 5pm on the Tuesday prior to camp starting to avoid being charged in full.
- The only way to cancel a camp is to complete the Camp Update form found online at playcheval.com. We will not be able to accept cancellations over the phone, through text messages, through email, etc. Once a camp fee is charged, they are nonrefundable.
- Late pickups: Camp ends at 6pm each day unless later pick up arrangements are made the week prior. Please be advised that you will be charged $2/minute for each camper who is picked up after 6pm. Therefore, please plan accordingly for evening traffic, as well as entry into the Cheval community.
- To better serve our staff and members, starting at noon on the Wednesday of the week prior to camp starting we will not be accepting any modifications to the campers' update form, and/or registrations for camps.
- Please address all of your billing inquiries to Sharon Foshey at sfoshey@playcheval.com..
Cancellation/Refund Policy
- Camp fees are not refundable after payment is made. The $25 deposit is not refundable, nor is it transferable to other camps. Fees for the programs are based on a per week basis. The Club at Cheval will not deduct days missed from your fee. When you enroll for a week of camp, you are reserving time, space, staff and provisions for your child, whether or not they attend. This policy does include any type of illness.
I have read and agree to Camp Cheval's payment and cancellation procedure. *

Yes
Credit Card Payment

For security purposes, we do not collect credit card numbers through this registration site. Therefore, after you submit this form, please go onto our website (playcheval.com) under youth programming, summer camp to complete the credit card authorization document. Once you've completed the form, you will need to email it to Sharon Foshey (sfoshey@playcheval.com).

PLEASE NOTE: Your registration is NOT complete until you have done the above step for payment.
I have read and agree to Camp Cheval's payment procedure. *

Yes
Confirmation

By acknowleding and submitting the camp registration, I am delivering an electronic signature that will have the same effect as an orginal manual paper signature and will therefore be as binding as a paper signature.
Should be Empty:

Camp Cheval Camper Registration

Camper(s) Information

Camper's Address

Parent/Guardian Information

Authorized Pick Up List

Emergency Contact Information