Camp I LOVE ME Registration Form

Camp I LOVE ME Registration Form

These forms are required for your children to attend camp.
June 1st - August 7thOther
CAMP WEEKLY FEE: $35 Camp Fee for the entire Summer: $350
Registration Information
Camper Name*
Nickname
Date of Birth*

MonthDayYear
Gender
Race
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact #1
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child*
Emergency Contact #2
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child*
Authorized Pickup: Name, Relationship, and Phone Number*
WalkerParent Drop off/pick upCamp I Love Me Van Rider

Walker Release Permission
I hereby give my child permission to walk or ride their bike from I Love Me Camp. Once your child is released from the program, I Love Me Camp is no longer responsible for the camper.

Camper permitted to walk walking from Address walking to; walking to
Name

First NameLast Name
Signature*
Medical Release Permission
I parent/guardian name give CAMP I LOVE ME permission to seek medical attention for my child is case of emergency. I prefer my child to be transported to the closest medical facility. I give CAMP I LOVE ME to make decision on behalf until a parent or guardian arrival at medical facility,
Signature*

SUMMER CAMP RELEASE

FOR Camp I LOVE ME SUMMER CAMP (MINORS)
Child Name:
Parent Name:

Type a question

Rows	Parent/Guardian Initials	*Do or Do Not
A. I parent/person having legal custody/guardianship of the above said minor, gives permission for the minor to participate in all camp activities at Camp I LOVE ME
B. I have received a copy of I love Me Camp policies pertaining to the admission, care, and discharge of children.
C. I give permission for my child to be photographed by I love Me Camp with the understanding that these photos can be used in promotion material and social media.
D. When my child is ill, I understand and agree that he/she may not be accepted for care or remain in care.
E. I authorize Camp I Love Me to seek medical attention on behalf of my camper if needed
F. I give permission for my child to participate in all field trips. I understand that I will be notified in advance when they are planned.
G.
H. I Release Camp I LOVE ME, its directors, officers, employees, and volunteers (collectively “Releases”) from all liability to me for any loss or damage to property or injury or death to person, whether caused by releases or otherwise and while such minor is in or near Youth Summer Camp.
I. I agree not to sue releases for any loss, damage, injury or death described above and I will indemnify and hold harmless releases and each of them for any loss, liability, camp; whether caused by the negligence of releases or otherwise.
J. I assume full responsibility for, and risk of bodily injury, death or property damage due to the negligence of releases or otherwise.
K. I do hereby authorize Camp I LOVE ME as an agent for the undersigned, to consent with respect to said minor, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or of the Missouri Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that Camp I LOVE ME is not responsible for costs incurred for medical care.
L. Camp I LOVE ME may use my child’s photo for promotional purposes. I intend for this document to be as broad and inclusive as is permitted by the laws of the state of Missouri; if any portion thereof is held invalid, I agree the balance shall continue in full legal force effect.
M. Acknowledge that (I) I have read this document, (II) I have inspected Camp I LOVE ME facilities and equipment, (III) I accept them as being safe and reasonably suited for the purposes intended, and (IV) I voluntarily sign this document.

Sign Document*
Date

MonthDayYear
Date

Field Trip and Activity Release Form

Camp Activities
● Science
● Photography
● Gardening
● Outside Sports
● Computers
● Life Skill Curriculum
● Art
● Water Play
● Stem project
● Social Emotional Learning Activities(Kindness, Gratitude, Affirmation Coping Skills)
● Math
● Reading
● Character Building (Empathy, Cooperation, Respect, Responsibility, Resilience and Perseverance
● Crafts
● Journaling
● Steam Bus
● Art Bus
● Knitting
● Money Management
● Entrepreneurship
I give my camper permission to participate in all activities with CAMP I LOVE ME this summer. I understand that and activity are subject to change.
Name
Signature*

Field Trips
● Swimming at Oakland or Jefferson City Aquatic Center
● Fire Station Tour(Columbia, MO)
● Skating at Skate 8(Jefferson City, MO)
● SkyZone(Columbia, MO)
● Level Up(Columbia, MO)
● Forum 8 Theater (Columbia, MO)
● Capital(Jefferson City, MO)
● Runge Conservation (Jefferson City, MO)
● Farmer’s Market (Columbia, MO)
● Mizzou Museum(Columbia, MO)
● Tour Of MU Campus(Columbia, MO)
● Cosmo Park(Columbia, MO)
● Devil’s Icebox (Columbia, MO)
● AMF Bowling Alley (columbia, MO)
● Arc(Columbia, MO)
● Science Center(Kansas City or St. Louis,MO)
● Magic House(Kansas City,MO)
● Chief Stadium(Kansas City,MO)
● Mark Twain Landing(Monroe City, MO)
● Zoo(St.Louis, MO)
● Aquarium(St Louis, MO)
● Big Surf Waterpark(Linn Creek, MO)
● Wolf Indoor Water Park(Kansas City, Kansas)
● Main Event (St Louis,MO)
● Slick City(St Louis, MO)

I give my camper permission to participate in all field trips with CAMP I LOVE ME this summer. I understand that field trips are subject to change
Name
Signature*

CAMP I LOVE ME BEHAVIOR CONTRACT
Camp Behavior Expectations:
1. Treat Everybody with Kindness and Respect.
2. Respect the Property of I love Me Camp And Others
3. Respect Other’s Feelings and Differences
4. Have Fun and Be Willing To Try
5. Use appropriate language at all times
6. Ask for help from a counselor when you have a problem or see others facing an issue
7. Be Responsible for your belongings
8. Camper must stay with assigned group at all time
9. Nobody gets to make your body feel unsafe and you don’t get to make anybody else feel unsafe.
10. Campers will never touch anybody inappropriately.
11. Campers are expected to participate in all activities
Campers will avoid following behaviors:
1. Fighting, rough housing or engaging in unsafe behavior.
2. Threatening or bullying anybody or joining in when others are bullying somebody.
3. Cursing and using derogatory language
4. Taking things that don’t belong to me.
5. Being disrespectful to staff or other campers. This includes “trash talking” or being intentionally mean
6. Bring electronics or toys from home.
7. Bringing any weapons, drugs or alcohol to camp.

Failure to follow these expectations will result in consequences to be determined by the Director. These behaviors can result in termination from the camp.

I have read and discussed the expectations of I LOVE ME CAMP along with my camper and will help to ensure that my camper will follow all rules and expectations of the camp. By breaking the rules and expectations, my camper and I understand that my camper could be asked to leave the program and no refund will be given.
Parent/Guardian's Name
Parent/Guardian's Signature*
Child's Name
Child's Signature*

Registration Payment
Pay in fullMake weekly payments
Should be Empty:

Camp I LOVE ME Registration Form

Registration Information

Identifying Information

Emergency Contacts/Authorized Pickup

Emergency Contact #1

Emergency Contact #2

Walker Release Permission

Medical Release Permission

Medical / Health Information

SUMMER CAMP RELEASE

Camp I LOVE ME Permissions

Field Trip and Activity Release Form

Field Trips

CAMP I LOVE ME BEHAVIOR CONTRACT

Registration Payment