Barrett Youth Enrichment Summer Camp

Barrett Youth Enrichment Summer Camp Registration 2025 **Entering 1st through 6th grade only Fall 2025**

This program is designed to reinforce key concepts learned during the school year, helping to prevent learning loss over the summer. It offers a variety of activities, including academic enrichment, organized sports, recreational activities, computer classes, music, art, and exciting field trips. Please note, **registration must be completed for each camper** Summer camp is available to students entering **1st through 6th grade only** Free lunch and afternoon snacks** will be provided daily.
Camper Information
Camper's Name*

Last NameFirst Name
Birth Date*

MonthDayYear
Grade from the 2024-2025 Academic School Year:*
(Grade entering in Fall 2025 Academic School Year)*
School Attended for the 2024-2025 Academic Year:*
Gender*

MaleFemale
Shirt Size*

Youth X-Small (4-5)Youth Small (6-8)Youth Med (10-12)Youth Large (14-16)Youth X-Large (18-20)Adult SmallAdult MediumAdult LargeAdult X-LargeAdult 2X
Upload your child's last Report Card here.

Cancelof
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Cell/Main Contact Number*
E-mail*
example@example.com
Are you interested in volunteering or chaperoning? (Please note, a background check is required.) Volunteer opportunities include tasks such as stuffing backpacks, assisting with the End of Year Celebration, and more. Chaperone opportunities include accompanying students on field trips.*

Volunteer YESChaperone YESNO
Emergency Information
1.Emergency Contact's Name*

First NameLast Name
Cell/Main Contact Number*
Relationship to Camper*
2.Emergency Contact's Name*

First NameLast Name
Relationship to Camper*
Cell/Main Contact Number*
Medical Information
Physician Name*

First NameLast Name
Physician Phone Number*
Medicaid*

YesNo
CHIP*

YesNo
Does your child have any serious health issues?*

YesNo
If you answered yes to the above question, please explain
Can your child participate in recreational activities:*

YesNo
If you answered no to the above question, please explain
Is your child currently taking any mediciations?*

YesNo
If you answered yes to the above question, please list explain
If your child suffers from allergies, please list or type No*
Transportation Information
My child will*

WalkRide a bikeCar Rider
If your child is a car rider, I authorize the following people to pick my child up from the Barrett Youth Summer Enrichment Program: Please complete the information below. (Authorized persons will be asked to produce photo ID)
1. Contact's Name*

First NameLast Name
Cell Number*
2. Contact's Name

First NameLast Name
Cell Number
Informed Consent and Acknowledgement
- I hereby give my approval for my child’s participation in any and all activities prepared by the Barrett Youth Summer Enrichment Program staff and Harris County Precinct 3 during the summer camp. In exchange for the acceptance of said child’s candidacy by the Barrett Youth Summer Enrichment Program staff, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless to Barrett Youth Summer Enrichment Program staff 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 Barrett Youth Summer Enrichment Program staff including 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, and outside activities that will provided for the cummer camp, some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
- I understand it is my responsibility to pick my child up at the designated closing time. If I am late, I understand that I will have to come in and sign for my child. I further understand that my child may be dismissed from the program when I am late three (3) or more times.
- If, for any reason, my child must go home in a manner not disclosed on this form, I understand that I have to call the Community Center and inform the staff of these changes.
Informed Consent and Acknowledgement Signature*

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Medical Release and Authorization

As Parent and/or Guardian of the named athlete, 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 athlete. 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 the Barrett Youth Summer Enrichment Program staff and its affiliates including Directors, Teachers, Coordinators, Summer Camp Counselors 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.
Medical Release and Authorization Signature*

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Field Trips and Transportation
I give permission for my child, First Name* Last Name* to be transported by the Barrett Youth Summer Enrichment Program staff, in collaboration with Harris County Precinct 3 Transportation, for field trips that require travel to and from the Barrett Youth Summer Camp Enrichment Program at the Riley Chambers Community Center.
Media

I authorize the 2025 Barrett Youth Summer Enrichment Program staff to photograph, audiotape and/or videotape mychild and use these media for program brochures, websites, presentations, and other promotional uses deemed
appropriate.

I give permission for my child to have access to the Harris County Precinct 3 Computer Network. This access includes and is not limited to the use of the 2025 Barrett Youth Summer Enrichment Program computers & tablets. I understand that this access is for educational use only. It is the responsibility of my child to restrict use for the stated purposes of the lesson and projects assigned. I understand my child will comply with the acceptable use and behavior conditions regarding the use of the network in the 2025 Barrett Youth Summer Enrichment Program. Should my child fail to comply with these conditions, I understand that their computer privileges at the 2025 Barrett Youth Summer Enrichment Program may be revoked.
Media Signature*

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Liability

It is understood that precautions will be taken in the interest of the student’s safety and well-being. It is further understood that the 2025 Barrett Youth Summer Enrichment Program, and Crosby ISD programs do not have insurance for students participating in the 2025 Barrett Youth Summer Enrichment Program. I agree that staff members, field trip sponsors, field trip volunteers, and adult chaperones will not be held responsible for any accident or misfortune in connection with the program, field trips, special events, and daily activities. I understand that 2025 Barrett Youth Summer Enrichment Program will not be responsible for lost, stolen, or damaged items
Liability Signature*

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Policies and Procedures

I understand there may be times when the information provided to Harris County Precinct 3, may be released upon request. This consent is intended to comply with the requirements of the Public Information Act, Tex Gov’t Ann. Sec. 552.137, as amended, and shall survive termination of this Program Year. I have received, read, and willingly agree to the Policies and Procedures contained in the Parent Information Guide for the 2025 Barrett Youth Summer Enrichment Program
Policies and Procedures Signature*

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Code of Conduct and Behavior Guidance Policy
CODE OF CONDUCT EXPECTATIONS (Three Rs)

The Barrett Youth Enrichment Summer Camp is designed to provide a safe and fun learning experience for all who attend. In order to meet this goal, enrollees are expected to behave appropriately and interact with staff and other students in a safe and respectful manner.

To simplify the code of conduct, The Barrett Summer Youth Enrichment camp
will follow the three R’s:

Always do the RIGHT THING (especially when no one is looking)
Although making the right choice at all times can be difficult, the expectation of those enrolled in the youth summer enrichment program is that everyone will do their best to make the right choice. And for those times that students fall short, staff will encourage and expect them to be honest about their mistakes and choose to make a better
choice next time.

Always be RESPONSIBLE (also known as personal accountability)
Enrollees are responsible for their actions. The expectation is that all students will refrain from horseplay, fighting, inappropriate touching, name-calling, or bullying of any kind. They are responsible for camp property and equipment and using supplies appropriately and safely.

Always RESPECT yourself and others (always!)
This embodies respect not only for other students and their contributions to activities and discussions but also
to staff and their instructions and the facility and property at the site of the enrichment program.
Code of Conduct and Behavior Guidance Policy Signature*

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Barrett Youth Enrichment Summer Camp Registration 2025 **Entering 1st through 6th grade only Fall 2025**

Camper Information

Medical Information

Transportation Information

If your child is a car rider, I authorize the following people to pick my child up from the Barrett Youth Summer Enrichment Program: Please complete the information below. (Authorized persons will be asked to produce photo ID)

Field Trips and Transportation

Barrett Youth Enrichment Summer Camp Registration 2025 Entering 1st through 6th grade only Fall 2025