Camp Registration

1

Choose Camp Session* This field is required.Choose between monthly or weekly sessions

MONTHLYWEEKLY

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Choose Monthly Camp Session* This field is required.

June 1 - June 26

June 29 - July 24

3

Choose Weekly Camp Session* This field is required.

June 1 - June 12

June 15 - June 26

June 29 - July 10

July 13 - July 24

4

Camper's Name* This field is required.

First Name

Last Name

5

Age* This field is required.Age on or before September, 30

6

Birth Date* This field is required.

Date

7

Gender* This field is required.

Male

Female

8

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

9

School and Grade* This field is required.

School

Grade

10

Select Camper T-Shirt Size* This field is required.If camper is enrolled for the month, it includes two shirts, but if you enroll by the week, it's just one shirt.

Youth XS (2-4)

Youth S (6-8)

Youth M (10-12)

Youth L (14-16)

Small

Medium

Large

XL

11

Do you want extra T-Shirts?* This field is required.Extra T-Shirts have a cost or $15 each

YESNO

13

FriendsThe camper will be arranged with 1 or 2 friends, depending on the availability of the age group.

Name

Age

Name

Age

Name

Age

14

Do you have siblings attending Camp this year?* This field is required.You have to complete one registration for each child

YESNO

15

SiblingsPlease add any sibling that is attending Camp this year

Full Name

Age

Full Name

Age

Full Name

Age

16

Does the camper know how to swim?* This field is required.

YESNO

17

Parent / Guardian* This field is required.

Full Name

Relationship

Phone Number

Email

Full Name

Relationship

Phone Number

Email

18

Who does the camper live with?* This field is required.

Mother

Father

Both

Other

19

Are you a member of Caparra Country Club?* This field is required.*The members discount is limited to the primary dependents only.

YESNO

20

Please include your CCC Members number*The members discount is limited to the primary dependents only.

21

Would you like to add extended care (4:30-6:00 pm) for an additional $199?* This field is required.

YESNO

22

Who is authorized to pick up the camper?Add each in order of priority. DO NOT ADD PARENTS OF CAMPER.

Full Name

Phone Number

Full Name

Phone Number

Full Name

Phone Number

Full Name

Phone Number

23

Emergency Contacts* This field is required.

Full Name

Relationship

Phone Number

Email

Full Name

Relationship

Phone Number

Email

24

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.* This field is required.

25

Does the camper take any medications? If yes, please describe.* This field is required.

26

Is the camper prescribed an inhaler? If yes, please explain any instructions.* This field is required.

27

Camper's Photo 2" x 2"

Drag and drop files here

Select files to upload

Max. file size: 2.9MB

28

Add Signed Medical Form

Drag and drop files here

Select files to upload

Max. file size: 2.9MB

29

Add Proof of Vaccination

Drag and drop files here

Select files to upload

Max. file size: 2.9MB

30

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Caparra Summer Camp during the selected camp. In exchange for the acceptance of said child’s candidacy by Caparra Summer Camp, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Caparra Summer Camp and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Caparra Summer Camp, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

31

Promo & Advertising Consent* This field is required.Do you give permission for Caparra Summer Camp and/or CCC to use photos and/or videos of my child/participant in their promotional material, including online media, for official camp purposes. This includes the use and printing of the photos in whole or in part, individually or with other images, videos, articles, and information. By signing this form, I release Caparra Summer Camp and/or CCC, and any camp personnel or sponsoring entity, from any liability that may result from the use and publication of these photos.

YESNO

32

CLICK HERE TO DOWNLOAD MEDICAL FORM

33

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Caparra Summer Camp and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

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Rules and Requirements:

Before the start of the camp, all campers are required to submit the following documents: registration form, 2 passport-sized photos, medical history, and vaccination record (green).
The camp fee must be paid in full prior to the start of the camp, and there will be no refunds. All sales are final and non-refundable. No exceptions.
We accept major Credit Cards (Visa, Master Card) Checks and Cash.
Please note that the fee for excursions is not included in the registration fee, and payment must be made in cash along with the permission slip. Refunds will not be given for excursion fees.
Campers' registration fee includes basic accident coverage, and their existing medical insurance will be complementary.
As a preventative measure, campers who are sick cannot attend the camp until they provide a medical certificate stating otherwise.
Only individuals authorized by the parent, guardian, or tutor are permitted to pick up campers. Authorized individuals must present a photo ID and sign a pick-up sheet.
Campers are required to wear their complete uniform, which includes a camp T-shirt, appropriate recreational pants, and shoes, during the camp and excursions.
We are not responsible for valuable items such as electronics, cell phones, toys, and clothing, and it is recommended not to bring them to the camp.
Parents or guardians must pick up their children between 3:30 p.m. and 4:30 p.m. It is crucial to be punctual during pick-up time, and a late fee of $30 for every 30 minutes or fraction thereof will be charged and must be paid in cash upon picking up the child.

Required Equipment for Campers:

Camp T-shirt
Appropriate recreational pants
Appropriate recreational shoes
Backpack
Alcohol or hand sanitizer
Water
Swimsuit
Towel
Sunscreen
Hat
Life jacket (if necessary)
Campers aged 4 must bring a mattress for the rest period.

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Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

36

Today's Date

Date

37

Signature* This field is required.