Peace, Liberation & the Arts Summer Camp 2023: Application Packet

Peace, Liberation & the Arts (PL&A) Summer Camp is a FREE summer camp for students age 13-18.

Camp is held on weekdays, M-F, from 9:30am - 3:00pm.

It runs Thursday, July 20th to Friday, August 4th.

Camp will take place at the 4 Circles Beyond Chester House (2100 Providence Ave, Chester, PA)

 

Camp Leadership

Ahmad Williams: Camp Director 

Margo Schall: Camp Assistant Directror

NOTE: Parents and caretakers are invited to join us at the Chester House (2100 Providence Ave, Chester, PA) on Tuesday, July 17th for an important pre-camp family orientation session. During this session, you will have the opportunity to meet the camp leadership, review the camp programming and rules, as well as to ask any outstanding questions.

 

This application has 4 sections, and must be fully completed. To begin, click 'next.'

For emergency contacts, please DO NOT list the main guardian filling out this form with the student. List two individuals who will be authorized to act on your behalf should you be unavailable.

Please note our EMERGENCY PROCEDURES:

In the case of injury, illness or any other emergency pertaining to your child, the staff will adhere to the following procedures:

1. The camp staff will call the main guardian contact number listed.

If there is no answer,

2. The camp staff will call the other two emergency telephone numbers listed.

If none of the above can be reached, the staff will call an ambulance, if necessary, to transport the child to a local medical facility.

Based on the medical judgment of the attending physician, the child may be admitted to a local medical facility.
The camp staff will continue to call the parents/guardians until one is reached.

COVID-19: We ask that anyone with exposure to COVID-19 or COVID-19 symptons stay home from camp until you test negative. 

 

PLEASE READ IN FULL

 

Participation in the Peace Liberation and Arts Camp requires that you adhere to the following rules. These rules are in effect for the length of time that you participate in the program. Read the statements below carefully. Your signature on this form reflects that you have read, understood, and agree to comply with all commitment statements listed.
____________________________________________________________________

 

I will follow all the rules of the Peace Liberation and Arts Camp including but not limited to:

1. Participating in the creation of and adhering to a group agreement throughout the camp

2. Checking cell phones with the directors daily for the duration of the camp day

3. Wearing appropriate clothing.

4. Refraining from fighting, bullying, harassment, offensive language and threats toward staff or other camp participants. This includes doing so verbally, physically and/or electronically for the entire camp.

5. Refraining from the use of tobacco products, drugs or alcohol. Anyone determined to be under the influence of any substance will be sent home.

- I understand that for dates July 20th - August 4th, 2023 the Camp meets weekdays at Chester House (2100 Providence Ave, Chester, PA).

- I understand and agree to attend the two night retreat at Temenos Retreat Center. I will adhere to any additional rules that may apply based on the program guidelines of organizations hosting our camp for off-site activities (i.e. Temenos & the one-full day off site trip) and will respect any off-site staff.

- I also understand that Violations of the Peace Liberation and Arts Camp rules may result in immediate dismissal from the camp.

- I will demonstrate positive attitudes and responsible behaviors.

- I will be friendly, helpful and engaging with other students, staff and other individuals in the camp.

- I will participate in the workshops and other enrichment opportunities offered to me during the Peace Liberation and Arts Camp.

- I understand that my parents/guardian will be financially responsible for any damages that I may cause while in the camp.

- I recognize and understand that failure to meet any of these requirements could result in being released from the Peace Liberation and Arts Camp at any given time.

 

CARETAKER, PARENT, GUARDIAN PERMISSION FORM

 

Student Name: _______________________________ has my permission to participate in all Peace Liberation and the Arts Camp weekly events, field trips, and the 2-night, 3-day sleep away camp. This permission extends to all Peace Liberation and the Arts Camp activities, and waives any claim for injury or damage by said participant while taking part in the Peace Liberation and the Arts Camp activities during the 2023 Summer session. In addition, if I do not provide insurance for my child, I will assume all responsibilities and costs associated with any medical emergencies and doctor visits due to injuries of any nature. 

 

PEACE LIBERATION AND the ARTS CAMP MEDIA PERMISSION FORM 

I understand that any audio, photographs or videos taken of participants by the Peace Liberation and the Arts Camp staff during the program may be used for Peace Liberation and the Arts Camp promotional use both in print and electronic form on 4 Circles Beyond, Inc. and program affiliate websites. I give the camp’s staff permission to use images of my child for this purpose.

 

*COVID-19 GUIDELINES: We ask that anyone with exposure to COVID-19 or COVID-19 symptoms stay home until you have received a negative test*

 

***The caregiver or guardian submitting this application understand that by signing below, they are agreeing to the PLA Camp Guidelines above.***