Parent/Legal Guardian Info

Emergency Contacts

Release Forms

Media Release

I, as the parent or guardian of below-named child, hereby give Community Collaboration of Delaware (CCD) and its employees, representatives, and authorized third party media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media.

Data Release and Consent

We hope you will allow your child to participate in Community Collaboration of Delaware (CCD) study to measure our program's impact. This study will assess your child’s growth during both the summer and the academic school year; specifically, we will measure growth in literacy, critical thinking, and sense of self. Impact will be measured through data collected during the summer and data shared by Colonial School District. Data sharing between Community Collaboration of Delaware and Colonial School District is only applicable to students who attend Colonial District schools. If you agree to participate, Community Collaboration of Delaware will collect data related to literacy, critical thinking, and sense of self during your child’s participation in the Summer Learning Academy at Carrie Downie Elementary. Your child’s privacy is our priority; all data sharing between Community Collaboration of Delaware (CCD) and the school district will be in full compliance with Family Educational Rights and Privacy Act (FERPA), the federal education data privacy law.

I hereby grant permission to Colonial School District to share with Community Collaboration of Delaware (CCD) all requested forms and information, including my child’s emergency contact information, health forms, and relevant permissions. Additionally, I grant permission for the Delaware Department of Health and Social Services to share with Community Collaboration of Delaware (CCD) and Colonial School District all requested forms and information related to eligibility and receipt of public assistance for reporting purposes. I attest that my child is fit for and medically able to participate in Summer Learning Academy activities. I understand that the Summer Learning Academy activities have inherent risks and on behalf of my child I hereby assume all risks and hazard incidents to my child’s participation. In consideration for permitting my child to attend the Summer Learning Academy, I hereby forever waive, release and give up any and all claims, demands, liability, damages, costs and expenses of any kind whatsoever, including property loss, personal injury, or wrongful death, against Community Collaboration of Delaware, Colonial School District and each of their respective agents, employees, officers, directors, participants, coaches, instructors, transportation providers, contractors, volunteers, other representatives, and heirs, which may arise from my child’s attendance at, participation in, or transportation to/from the Summer Learnring Academy.

First Aid/Emergency Medical Release

I give my permission to the CCD staff to administer basic first aid to my child by phone when needed. I also understand that I will be informed of any injuries attained by my child when I pick him/her up from the program. The health history the school district has is correct and complete to the best of my knowledge and the camper described has permission to engage in all camp activities, except as noted on the registration forms. I give permission to the medical personnel selected by the camp director to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for me/or my child. All important medical information for my child has been documented on the medical and individual care plan forms. In the event I cannot be reached in an emergency, I give permission to the physician selected by the camp director and/or nurse to secure and administer treatment, including hospitalization, for the person named above. This form may be photocopied for trips out of camp. In the event that I cannot be reached in an EMERGENCY, I give permission to the physician selected by the program director and/or nurse to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above.

Screen Time Permission

My child may, as part of a scheduled activity, watch educational and/or program based programs or movies during the day and/or use a computer for up to one hour per day.

Dress

I understand that the below-named child will spend a portion of the day outdoors; weather permitting. I understand that appropriate attire for weather conditions and enclosed toe shoes must be worn and that sunscreen is my responsibility.

Meals and Snacks

I understand that breakfast and lunch will be provided by the Summer Learning Academy, but I may choose to pack my child’s meals. I understand there will NOT be access to a microwave for food which needs to be heated. I also understand that campers will be NOT able to order or receive “take out” at the Summer Learning Academy.

Electronics

I acknowledge that my child is responsible for any personal belongings that are brought to the Summer Learning Academy. In addition, I understand and agree that Community Collaboration of Delaware (CCD) is not responsible for any personal items regardless of the value that may be lost, stolen, or destroyed, even if the item is confiscated while a member is attending the Summer Learning Academy. I acknowledge that cell phones may not be used, must be turned off while at the Summer Learning Academy and must be out of sight. In addition, I understand that personal electronics and other computer devices are not permitted at the Summer Learning Academy. I understand that staff will confiscate any device that my child brings to the Summer Learning Academy.

1st Incident: To the best extent possible, the child will be moved to a private setting with a camp staff member and camp supervisor. The child will receive an explanation as to why their behavior was inappropriate and will receive a verbal warning.

2nd Incident: Camp leadership will determine an appropriate consequence for the child's action. This may include restrictions from further activity or quiet time away from other campers. The child's parent/guardian will be notified of the behavioral problem.

3rd Incident: Parent/guardian will be contacted and asked to pick up the child.

For incidents involving serious misconduct (including but not limited to bullying, intimidation of fellow campers, fighting, etc.) the parent/guardian will be required to pick up the child. Camp leadership will determine the appropriate disciplinary action. Additionally, the child will not be permitted to return to camp until a meeting can be arranged between camp leadership, the parents/guardians, and the camper.

Health Information Form

Information may be shared with appropriate school and camp personnel for health purposes. By signing below, you give the Summer Learning Academy nurse permission to administer the above medication as needed.