JA BIZTOWN SUMMER VENTURE CAMP REGISTRATION

JA BizTown Summer Venture Camp
Is your child an upcoming 4th-7th grader? Are they real world ready? JA BizTown Summer Venture Camp is designed to jump start your child's entrepreneurial spirit. Campers may not be old enough to drive, vote or work, but that won't stop them from starting their own company and earning a profit as they become JA BizTown citizens this summer!

Campers can look forward to:
- Hands-on experience relating to entrepreneurship, financial literacy, and work readiness.
- Complimentary T-shirt, enrichment materials, and JA BizTown souvenirs.
- A chance to meet new friends, hold a dream job, and have fun!
Date: June 26-30, 2023

Time: Monday - Friday, 9:00AM-3:00PM

Location: JA Youth Workforce & Innovation Center

1725 Twin Springs Rd Baltimore, MD 21227

EARLY-BIRD PRICE: $250 per child, ends April 23

After April 23: $300 per child

Age: rising 4th- 7th graders

Advance registration required - Space is limited. Registration ends June 18, 2023
Camper Information

Use a separate form for each camper. Registration is not complete until the fee is paid. You will be directed to a secure online payment form after registration.
Camper's Name*

First NameLast Name
Camper's School Name*
Camper's Date of Birth*

MonthDayYear
Camper's Gender*
Camper's Home Address*

Street Address

Street Address 2

CityState / Province

Postal / Zip Code
Camper's T-shirt Size:*

Adult X-SmallAdult SmallAdult MediumAdult LargeAdult X-Large
Has your child previously attended JA BizTown?*

YesNo
How did you hear about JA BizTown Summer Venture Camp?*

Returning familyJA BizTown AttendanceJA Email CommunicationsSchool System CommunicationsSearch Engine (Google, Bing, etc.)Social MediaEducator RecommendationFamily/ Friend RecommentationOther
Parent/ Guardian 1 Contact Information
Parent/ Guardian 1 Name*

First NameLast Name
Relationship to camper*
Parent/ Guardian 1 Cell Phone Number*
Please enter a valid phone number.
Parent/ Guardian 1 Email*
example@example.com
Parent/ Guardian 1 Address (If different from child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian 2 Contact Information
Parent/ Guardian 2 Name

First NameLast Name
Relationship to camper
Parent/ Guardian 2 Cell Phone Number
Please enter a valid phone number.
Parent/ Guardian 2 Email
example@example.com
Parent/ Guardian 2 Address (If different from child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

Please include the name of an additional emergency contact in case parent/ guardian is not reachable.
Emergency Contact Name (other than custodial parent)*
Emergency Contact Email*
example@example.com
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Camper*
Persons Authorized to Pick Up Camper

Please give full names and fill in all of the information. List two people who are authorized to pick up your camper and can be contacted in times of emergencies. All persons listed must show ID each time when picking up camper.
Name*

First NameLast Name
Relationship to Camper*
Phone Number*
Please enter a valid phone number.
Name

First NameLast Name
Relationship to Camper
Phone Number
Please enter a valid phone number.
Is there legal documentation prohibiting your child from being in contact with any individual that the staff of Junior Achievement of Central Maryland, Inc. should be made aware of? If you check yes, please provide proper documentation to Keri Slemp at kslemp@jamaryland.org*

YesNo
Medical Release Information

I do hereby grant permission to Junior Achievement of Central Maryland, Inc. and their respective agents and employees to secure such medical aid and hospital services as they deem necessary for the child noted on this form in the event the child should sustain injury or illness while attending a summer program. I agree to assume cost for transport and medical treatment in such an emergency situation. I have also indicated below any medical information of which Junior Achievement of Central Maryland, Inc. should be aware in consideration of the child's physical and mental wellbeing.
Camper's Physician*
Physician's Phone Number*
Please enter a valid phone number.
Special Notes (Allergies, Health Conditions, etc.)*
If none, please enter N/A
Insurance Carrier*
N/A if not insured
Policy Number*
N/A if not insured
Group Name*
N/A if not insured
Group Number*
N/A if not insured
Please sign the box in notice of your compliance with the above medical release information.*

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Date*

MonthDayYear
Date
Camper's Medication Information
Please list all medications that your camper is currently taking.
Will your camper need to take any medications while attending JA BizTown Summer Venture Camp?*

YesNo
If you answered Yes, please list any medication to be taken while onsite. Please include name, purpose, dosage, frequency, possible side effects, etc. You will also be required to complete a Medication Authorization Form as well as provide necessary medication in the original prescription container with child's name and instructions on the label.
Waiver of Condition
I give permission for my child to receive medication from the Junior Achievement of Central Maryland, Inc. staff. Only staff who have completed CPR and First Aid training will be authorized to distribute medication. I will assume responsibility for safe delivery of the medication to and from camp by my child. I will notify the Junior Achievement of Central Maryland, Inc. if there are any changes in the use of the medication or prescribed treatment. I release and agree to hold all personnel of Junior Achievement of Central Maryland, Inc. harmless from any and all liability for damages for injury resulting directly or indirectly from this authorization.
I consent with the above Waiver of Condition:*

YesNo
Custodial Parent's Signature*

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Date*

MonthDayYear
Date
Camp Code of Conduct and Discipline Policy
All campers and parents participating in Junior Achievement of Central Maryland, Inc. camps must agree to follow the conduct and discipline policy. Failure to do so could result in dismissal from the program without refund.

Camp Code of Conduct:
- Use appropriate language.
- Avoid physical contact with other campers.
- Be respectful of JA staff and other campers.
- Behave in a manner that in not verbally or physically threatening.
- Behave in a manner that does not endanger themselves or other camper’s safety and welfare.
- Be tolerant and accepting of others in terms of race, religion and gender.
- Agree to follow posted rules regarding behavior, not limited to the items listed above.
Camp Discipline Policy:
- JA staff will alert parent of the problem behavior.
- JA staff will document the issue on the camper’s file.
- Parent will be required to pick up camper immediately if problem behavior continues.
- JA Capstone Director and Chief Academic Officer will determine if camper is allowed to return to camp.
I consent with the above Camp Code of Conduct and Discipline Policy:*

YesNo
Custodial Parent's Signature*

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Date*

MonthDayYear
Date
Camp Fees and Policies
JA BizTown Summer Venture Camp is Monday through Friday, June 26-30, 2023, from 9:00 a.m. to 3:00 p.m. The cost is $300 (early bird pricing of $250 ends April 23). Payment is due at the time of registration to reserve your camper's spot.

Drop Off Policy

Campers should arrive no earlier than 10 minutes prior to the program start time. If you arrive earlier, an adult must wait with camper(s) until the designated drop-off time. Please note that this is for the safety of all campers. Please notify JA if your camper will be late. Habitual lateness is grounds for dismissal from camp at the discreation of the Capstone Director and CAO.

Late Pickup Policy

Prompt pickup is vital.  Please consider weather/traffic conditions and have an alternative pickup plan with neighbors, relatives or friends to ensure on time pick-up. Please communicate with JA if you are running late!
- A flat fee of $25 will be assessed for the first late pick up offense. Payment is expected at time of pick up.
- If a second late pickup occurs, your child will be dismissed from camp.
- Capstone Director and CAO will be incharge of waiving fees due to any uncontrollable circumstance.
Cancellation Policy

In the event that cancellation becomes necessary, a written letter of cancellation must be received by Junior Achievement of Central Maryland, Inc.'s office.
- Cancellations received 30 days prior to the start of camp will be refunded in the full amount, less a $50 administrative fee.
- Cancellations received 29 days to 10 business days before the registered camp start date will be refunded 50% of the payment, less a $50 administrative fee.
- No refunds will be issued for camp cancellations less than 9 business days before the camp begins.
I consent with the above Camp Fee and Cancellation Policy:*

YesNo
Custodial Parent's Signature*

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Date*

MonthDayYear
Date
Student Media Release and Parental/Guardian Consent
Junior Achievement USA and Junior Achievement of Central Maryland (collectively “JA”) deliver educational programs to students in-person and online (“JA Programs”). When the Student participates in JA Programs digitally, the Student’s Likeness (defined below) may be captured and reproduced. This Student Media Release and Parental/Guardian Consent (the “Agreement”) (1) authorizes JA to use the Likeness of the Student as described below, (2) permits JA to use work product created by the Student in connection with JA (“Student Work Product”) and (3) allows JA to collect and use Student personal information in accordance with the JA USA Privacy Policy. For good and valuable consideration, including the opportunity to participate in JA Programs, I agree as follows:

Student’s Likeness
- JA may use Student’s name, voice, image, picture, silhouette, and other aspects of Student’s likeness (“Likeness”) in any recording, video, still-image, photograph, webinar, online event or other form of media (collectively, “Media”), in connection with JA Programs and/or the Student Work Product, or for any purpose related to JA, including with promotional materials, advertising, and publicity.
- JA will not permit use of Student’s Likeness by unaffiliated third parties, or for any third party commercial use or use contrary to JA’s educational mission of empowering young people.
Student Work Product
- I grant JA a perpetual, non-exclusive, irrevocable, sublicensable and royalty-free right to copy, distribute, publicly display, publicly perform, create derivative works, edit, enhance, publish and use any Student Work Product in any medium and in any manner throughout the world.
- I confirm that any Student Work Product that I furnish or allow JA to use does not infringe upon any copyright, trademark, trade dress, rights of privacy or publicity, patent rights or third party contract rights, does not contain libelous or scandalous matter, and is free of any third-party content or materials.
Privacy Consent
- To access web-based content and/or online Media, students may be asked to provide certain personal information, such as first and last name, email address, and username, which is collected and used in accordance with the Privacy Policy of Junior Achievement USA® (as updated from time to time, the “Privacy Policy”). I give my consent for JA to collect and use such Student personal information in accordance with the Privacy Policy.
I will not sue, dispute, challenge, or institute proceedings against JA for using the Student Work Product or Student’s Likeness in accordance with this Agreement, and I hereby waive all legal and equitable rights I may have as well as all claims, damages and expenses arising directly or indirectly from the same. I agree to indemnify, defend and hold JA harmless from any and all actions, damages, and liabilities (including attorneys’ fees and costs) that may arise by or in connection with a breach of my representations herein. I am under no obligation to sign this Agreement but so voluntarily understanding that this Agreement is binding on, and shall benefit, JA, me and our respective (as applicable) heirs, devisees, legatees, representatives, guardians, conservators, administrators, successors, assigns, agents, transferees and estates.
I consent with the above Student Media Release*

YesNo
Custodial Parent's Signature*

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Date*

MonthDayYear
Date
Your registration is NOT complete until payment is made!

When you click the CONTINUE button you will be redirected to the JA BizTown Summer Venture Camp payment page.

Once redirected, please complete the required information and scroll down to select payment via echeck or credit card. This link will also be provided in your email confirmation.

As a reminder- your child's spot will not be reserved until payment is received.

For any questions or for additional information, please contact Keri Slemp, Capstone Director, at kslemp@jamaryland.org or (410)363-6495.
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JA BizTown Summer Venture Camp

Camper Information

Parent/ Guardian 1 Contact Information

Parent/ Guardian 2 Contact Information

Emergency Contact

Persons Authorized to Pick Up Camper

Medical Release Information

Camper's Medication Information

Waiver of Condition

Camp Code of Conduct and Discipline Policy

Camp Fees and Policies

Student Media Release and Parental/Guardian Consent