Welcome to Project Right Direction Summer Camp Application!

Welcome to Project Right Direction Summer Camp Application!

Thank you for your interest in our upcoming summer camp program! Our camp is designed to provide a fun and enriching experience for children ages 7-14, focusing on outdoor adventures, creative activities, and valuable life lessons.
Session Information:

Session 1: June 3 - June 14, 2024 Time: 9:00 AM - 3:00 PM
Target Age Group: Youth between the ages of 7-10 years old (Grades 3-5)
Session 2: July 1 - July 12, 2024 Time: 9:00 AM - 3:00 PM
Target Age Group: Youth between the ages of 11-14 years old (Grades 6-8)
Camper Information: *

First NameLast Name
Date of Birth: *

MonthDayYear
Date
Grade: *
Pronouns:*
Gender: *
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any known allergies? (food, medication, environmental)*
This information will help us ensure the safety and well-being of your child during their time at our summer camp program.
Dietary restrictions or special dietary needs:*
This information will help us ensure the safety and well-being of your child during their time at our summer camp program.
Medical conditions or special considerations:*
This information will help us ensure that your child receives appropriate care and accommodations during their time at camp.
Current medications and dosage instructions:*
This information will help us ensure that your child receives appropriate care and accommodations during their time at camp.
Health insurance information:*
This information will help us ensure that your child receives appropriate care and accommodations during their time at camp.
Preferred hospital and physician information:*
This information will help us ensure that your child receives appropriate care and accommodations during their time at camp.
Please pick the appropriate session here: *
T-shirt Size*

Camper Information:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Grade:
Gender:
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any known allergies? (food, medication, environmental)
Dietary restrictions or special dietary needs:
Medical conditions or special considerations:
Current medications and dosage instructions:
Health insurance information:
Preferred hospital and physician information:
Which session would you to sign your youth up for?
T-shirt Size:
Pronouns

Parent/Guardian Information:
Parent/Guardian Name(s): *

First NameLast Name
What is your relationship to the youth?*
Parent/Guardian Phone Number:*
Please enter a valid phone number.
Parent/Guardian Email Address:*
example@example.com
Parent/Guardian Name(s):

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your relationship to the youth?
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email Address:
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Information (Other than Parent/Guardian):*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address:*
example@example.com
Relationship to youth:*
Authorized Individuals for Pickup: [Enter Names and Contact Information]*

Consent Statement:

I, First Name Last Name parent/guardian of First Name Last Name , at this moment, acknowledge and agree to the following terms and conditions related to participation in the Project Right Direction summer camp program:

Emergency and Medical Care: I understand that Project Right Direction and its staff will take all reasonable precautions to ensure the safety and well-being of participants during camp activities. However, I acknowledge that accidents, injuries, and medical emergencies may occur despite these precautions. At this moment, I release, discharge, and hold harmless Project Right Direction, its staff, volunteers, and affiliates from any liability for injuries, damages, or losses my child sustained during the summer camp program. I understand that Project Right Direction is not responsible for any medical expenses incurred due to injuries or illnesses sustained during camp activities. In a medical emergency, I authorize Project Right Direction staff to seek medical treatment for my child and consent to any necessary medical procedures deemed appropriate by medical personnel.

Photography and Video Release: I grant permission for Project Right Direction to take and use photographs/videos of my child for promotional purposes, including but not limited to social media, website, brochures, and other organizational content. My child's image may be used in promotional materials without further consent or compensation.

I understand that if I request a refund for camp fees, I must submit the request before April 15, 2024. Refunds requested after this date will not be issued under any circumstances. I acknowledge that I am responsible for reviewing and understanding the refund policy outlined in the Project Right Direction student/parent handbook before submitting my application.

I consent to allow my child to use the provided transportation, including the 15-passenger van, for field trips or other excursions organized by Project Right Direction.

I understand that Project Right Direction staff are mandated reporters and are required by law to report any suspected incidents of child abuse or neglect to the appropriate authorities.

I acknowledge that only individuals approved for pick-up on the camper's registration form can pick up the student from camp. No person not listed as an authorized pick-up person may pick up the student.

By signing below, I acknowledge that I have read, understand, and agree to the terms and conditions outlined in this consent statement.
Parent/Guardian Signature *

Clear
Today's Date*

MonthDayYear
Date

My Products

Embrace Your Shine Application: Pay in Full Option Product Image

Embrace Your Shine Application: Pay in Full OptionThe camp fee is $155.55 per child per session, including all taxes.

$150.00 Quantity

Embrace Your Shine Application: Payment Plan Option Product Image

Embrace Your Shine Application: Payment Plan OptionOur payment plan option provides flexibility for families who prefer to spread the program's cost over two installments. Here's how it works: - Two Installments: You can split the total program fee into two equal payments. - Scheduled Payment Dates: - For the June Session: - Payment 1: Due on April 26, 2024. - Payment 2: Due on May 17, 2024. - For the July Session: - Payment 1: Due on May 24, 2024. - Payment 2: Due on June 14, 2024. - Payment Amount: Each installment will be $50.00. By opting for the payment plan, you secure your child's spot in the program while managing your budget effectively. Please ensure payments are made on or before the specified dates to guarantee enrollment.

$50.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

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