2024 Camp Nia Registration Form
Camp will be held July 8-18, 2024 with a Camp Performance on Friday, July 19th Camp Hours: 9:30 am - 3:00 pm
Camp Nia is open to girls ages 11-14 and includes lunch and snacks. With an Afrocentric foundation, the camp addresses self-esteem, self-confidence, self-control, self-expression, cultural awareness, health & exercise, and proper diet via the performing arts. Four classes are offered: vocals, dance, drama, and stage design; and the girls select two classes to focus on for the duration of the camp. Classes are taught by experienced professionals in the craft being taught. The entire two weeks of Camp Nia are spent preparing for a culminating performance which is open to the community. Girls should only register if they will be able to attend camp daily and participate in the performance.
Camp is held Monday - Friday week 1, and Monday - Thursday week 2. The performance will be on Friday of Week 2.
The camp registration is first-come, first-served.
The camp fee is $200 per camper due by May 31. There are a limited number of HALF scholarships available on a 1st come, 1st serve basis.
Please complete the registration form to enroll your daughter.
Participant Information
Participant Name
*
First Name
Last Name
Age
*
Please Select
10
11
12
13
14
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Grade Level this for the 2024-2025 school year.
*
Please Select
5
6
7
8
9
10
T-Shirt Size (All girls will receive a camp t-shirt, they will be adult sizes.)
*
Please Select
Small
Medium
Large
X-Large
XX-Large
Class Selections
Please order from 1st - 4th your daughter's preferred class choices; please do not repeat selections, we will do our best to ensure your daughter is placed in her 1st and 2nd class choices. However, classes are assigned in order of received registration, therefore, we cannot guarantee choices. Class selections will be confirmed via email by June 15.
1st Choice
*
Please Select
Singing
Dance
Acting
Set Design (Art)
2nd Choice
*
Please Select
Singing
Dance
Acting
Set Design (Art)
3rd Choice
*
Please Select
Singing
Dance
Acting
Set Design (Art)
4th Choice
*
Please Select
Singing
Dance
Acting
Set Design (Art)
Attendance Expectation Acknowledgment
Daily attendance is critical. Inconsistent attendance and/or excessive tardiness is disruptive to the camp in preparation for the performance. We rely on parents to ensure their daughter arrives to and is picked up from camp on time.
I agree to make every effort to have my daughter to camp every day on time and to pick up on time.
*
Please Select
I AGREE
I DISAGREE
Parent Information
Parent/Guardian #1
*
First Name
Last Name
Relationship
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone #
*
Other Phone #
E-mail
*
example@example.com
Parent/Guardian #2
First Name
Last Name
Relationship
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone #
E-mail
example@example.com
Emergency Contacts
Emergency Contact #1
*
First Name
Last Name
Relationship
*
Phone Number
*
Emergency Contact #2
*
First Name
Last Name
Relationship
*
Phone Number
*
Medical Information
Please answer honestly; your honest responses will help ensure we have the most positive experience possible for your daughter.
Does your daughter have any food restrictions or allergies? Please note, lunch will be provided each day, however, if your daughter has a special diet we highly recommend you send her to camp with a lunch.
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None
Nut Allergy
Vegetarian
Vegan
Other
If you indicated "Other" above, please specify, otherwise please indicate N/A.
*
Does your daughter have any medical conditions we need to know about?
*
Please Select
YES
NO
If yes, please explain. If no, please type N/A.
*
Does your daughter have an IEP or a 504 Plan?
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Yes, she has an IEP.
Yes, she has a 504 Plan.
Yes, she has both an IEP and a 504 Plan.
No, she has neither an IEP nor a 504 Plan.
If you answered yes to the above question, please provide any information about her IEP or 504 Plan that teachers should know. If you answered No to the above question, please enter N/A.
*
In the event of an emergency, do we have your permission to seek medical care for your daughter?
*
Please Select
YES
NO
If yes, what is your hospital of choice? If no, please explain what you would like us to to instead.
*
Medical Insurance Carrier, If none, please indicate "NONE" in each of the boxes below.
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Policy #
*
Doctor's Name:
*
Doctor's Phone #
*
Informed Consent
All Camp staff are mandated child abuse reporters. Should a staff member learn that your daughter is being harmed, staff is mandated by law to contact Child Protective Services (CPS) without notifying the parent prior to doing so. Should we learn your daughter is harming herself, or considering harming herself, we will notify you immediately. Do you understand and agree with our Informed Consent?
*
Please Select
YES
NO
Media Release and License
I hereby grant Sisters of Nia, Incorporated an irrevocable License to use my daughter’s photograph, video, voice, or likeness of any kind, now or at any time in the future throughout the world in any manner it so chooses and in any medium now known (print, radio, TV, internet, etc.) or later developed, in an unlimited number of times in perpetuity. This includes, without limitation, media, marketing, advertisements, and any other promotional material it wishes. I also acknowledge that Sisters of Nia, Incorporated is under no obligation to use my daughter’s photograph, video, voice, or likeness of any kind, in any materials or manner it so chooses. I agree that no fees, commissions or royalties are to be paid to me or my daughter for the use of her photograph, video, or likeness of any kind. I further agree to waive any right to inspection or approval of the use of my daughter’s photograph, video, voice, or likeness of any kind. Additionally, I acknowledge that Sisters of Nia, Incorporated may rely on this permission and waiver at a substantial cost and I hereby agree not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder. I have read this Release and License and I fully understand the meaning and importance of its contents. I further acknowledge and agree that I have exclusive right and authority to sign this Release and grant this License.
*
Please Select
YES
NO
Camp Fee
There is a $200 program fee which is due no later than May 31. Payments are accepted via Zelle (ssmith@sistersofnia.org), CashApp ($Ssitersofnia), Venmo (@Sisters-of-nia), or PayPal (paypal.me/Sistersofnia). Please note, payments on PayPal require an additional $5.00 fee. Checks can also be mailed and received at the following address: Sisters of Nia, Inc., 9630 Bruceville Rd., Suite 106-318, Elk Grove, Ca 95757
Scholarships
We have a limited number of HALF scholarships available for families who would need one. Scholarships are available on a 1st come, 1st serve basis. If you are in need of a scholarship, please indicate so and use this link to apply: https://forms.gle/rEH5CrYJXzqqr8yr6
I agree to pay the $200 program in full by the due date. Remember complete the scholarship application if you need one...the link is above.
*
Please Select
YES
I need a HALF scholarship.
Parent Signature
Please sign as your consent for your daughter to participate in Camp Nia.
*
Submit
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