Oglebay Institute Summer Camp Health & Information forms

Camper Health & Information

Forms

Thank you for choosing Oglebay Institute Summer Day Camps!

Oglebay Institute requires the attached forms to be completed and returned 2 weeks prior to the first day of camp. No child will be admitted to camp without these forms. If a child arrives at camp without completed forms, they will be sent home and can return the next day with completed forms. This information is needed in order to effectively attend to your child's/children's needs during an emergency, illness, or other circumstance. Please complete each section fully.

Additionally, we ask that you review the Oglebay Institute Summer Camp Handbook located on the Oglebay Institute website at https://oionline.com/camps/parenthandbook/. This helpful guide introduces parents/guardians and students to summer camp policies and procedures, and it addresses frequently asked questions such as what to wear, pick-up procedures, lunch policies, etc. Please familiarize yourself with this information, review it with your child, and consult it throughout the camping season.

If you have any questions, please call our office before submitting your form. Once the form is submitted, changes cannot be made. We are happy to assist you. Any questions may be directed to the Administration Office at 304-242-4200 or email us at customerservice@oionline.com.

If mailing or faxing, please print the form and return to:

Oglebay Institute

Summer Camp Information

1330 National Road

Wheeling, WV 26003

Fax 304-242-4203

If you do not have printer access, a form can be provided to you by visiting an OI facility, or you may call 304-242-4200 to request one to be mailed to you.
Today's Date*

MonthDayYear
Date
Parent/Guardian Name (First & Last)*
Child's Name (First & Last)*
Phone (Home)
Phone (Work)
Phone (Cell)*
Email*
example@example.com
Child's Gender*
Child's Age*
Grade Child is Entering in Fall*
My Child will be attending the following week(s) of camp:

Click Here to refer to the day camp brochure for accurate camp names and dates.

Please list the FULL names of the camps.
June 2-6 Camp Name
June 9-13 Camp Name
June 16-20 Camp Name
June 23-27 Camp Name
July 7-11 Camp Name
July 14-18 Camp Name
July 21-25 Camp Name
July 28-Aug 1 Camp Name
Aug 4-8 Camp Name
Aug 11-15 Camp Name
Aug 18-22 Camp Name
CANCELLATIONS & REFUNDS
Oglebay Institute is committed to offering a wide variety of camps. As a result, camps sometimes have to be cancelled due to insufficient enrollment. In such cases, you will be notified no later than 72 hours before the camp start date, and the full fee will be refunded. Oglebay Institute reserves the right to substitute instructors.

For participants to cancel and receive a full refund, they must notify the facility and cancel at least 2 WEEKS before the camp start date. No refunds will be granted less than two weeks from the camp start date, and there is no proration of camp fees once the camp has started. A cancellation fee of $20 is in effect for ALL cancellations made after April 1, even those made within the two-week cancellation period.

Full payment is due at the time of registration.

I have read and agreed to the terms above.
Signature*

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Date*

MonthDayYear
Date
CAMPER HEALTH INFORMATION
If a child is ill, they should not attend camp and the parent/guardian should notify us to report illness. If you suspect that your child is ill, please keep your child at home to avoid unnecessary exposure to other campers or instructors. Please contact the camp director with any questions that you may have.

Please call the appropriate facility to report your child's absence.

Please let the staff know if your child has any food allergies, including wheat, dairy or peanuts.

Camp staff is NOT permitted, under any circumstances, to dispense medication. Please do not ask the staff to do so. The camp staff will only handle first aid situations.

Emergencies exceeding the knowledge of the instructor will be handled by WVU Medicine Wheeling Hospital, Inc. If the instructor does not deem the situation an emergency, parents will be notified and arrangements will be made for pick-up.
EMERGENCY INFORMATION
Emergency Contact Name*
Phone*
Relationship to Child*
Email
example@example.com
2nd Emergency Contact Name*
Phone*
Relationship to Child*
Email
example@example.com
Medical Insurance Provider*
Policy/Group #*
Child's Physician/Medical Care Provider*
Phone*
Please indicate emergency facility choice: WVU Medicine Wheeling Hospital, Inc. or Other. If other, please specify.*
CHILD HEALTH INFORMATION
Immunizations up to date (according to Ohio County Schools requirements)?*
Date of last tetanus shot.*
Allergies (including allergies to foods and medication).*
Please list any physical/behavioral reactions to allergens.*
Please list and explain any modifications or accommodations your child needs in order to participate.*
Dietary Restrictions*
Activity Restrictions*
If applicable to the camp(s) your child is attending, is your child allowed to take a swim test conducted by a certified lifeguard? If no, your child will not be permitted out of the 3ft. area.*

YesNoN/A
Other Needs (medical conditions, medications, etc.)*
By completing and signing this form, I hereby give my consent to Oglebay Institute for the following: Obtain emergency medical care for my child and administer minor first aid procedures. I hereby release and hold harmless Oglebay Institute, its employees, and its agents from any and all liability for any and all harm arising as a result of participation.
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
PICK-UP AND RELEASE AUTHORIZATION
A parent or guardian must accompany each camper to the facility every morning. Each child must also be signed out at the end of the day at the correct location. Campers are not permitted to sign themselves in or out. Please complete the following Pick-up and Release Information.

Should it become necessary to pick up your child before the end of camp, please notify the camp staff in advance if possible. You must report to camp staff before removing your child from the premises.

Please notify the camp staff if your child will be arriving late for camp.
I hereby authorize the following person(s) to pickup my child(ren) from Oglebay Institute's Summer Day Camps. If there are any changes in these arrangements, I will give advance written notice.

Note: If there are any special instructions, or any person(s) who are NEVER authorized to pickup your child, please indicate this information below.

If you need more space than provided, please contact the camp facility.

TRANSPORTATION

If your child is attending a camp that goes to the pool, by signing these information forms, you agree to allow your child to be transported via buses provided by Oglebay Institute or the Oglebay Park Trolley. On pool days, please plan to pick up your child(ren) at their designated pool: Oglebay or Wheeling Park.
Child's Name*
Parent/Guardian Name*
ALLOWED NAME 1*
Phone*
Relationship to Child*
Driver's License State and Number*
ALLOWED NAME 2
Phone
Relationship to Child
Driver's License State and Number
ALLOWED NAME 3
Phone
Relationship to Child
Driver's License State and Number
NEVER ALLOWED NAME 1
NEVER ALLOWED NAME 2
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
CODE OF CONDUCT
Students learn better in a secure, orderly, and non-disruptive environment. The goal of Oglebay Institute is to help students and teachers create an environment that is conducive to teaching and learning.

At Oglebay Institute, clear and reasonable rules are fairly and consistently implemented. Inappropriate or disruptive behavior by the student will not be tolerated and may result in removal of the student from the class or camp. Chronic offenders may be restricted from attending future classes or camps. No refund will be extended to expelled participants.

General Rules:

A safe and positive learning environment for students and adults is essential to our success. We appreciate your commitment to these principles.

1. Listen politely and follow directions.

2. Keep hands, feet, and objects to yourself.

3. Be courteous and polite. Respect the rights of others and respect the property of the organization.

4. Use appropriate language.

5. Be mindful of surroundings and always stay with your group.

Expectations for Student Behavior:

1. Students will arrive to class on time.

2. Students will listen carefully and respectfully to their instructors and administrators.

3. Students under the age of 18 will ask for assistance from the adults in charge should they have trouble with another student.
By signing below, the parent/guardian indicates that they have reviewed this information with their child and that they understand and agree to abide by this Code of Conduct.
Child's Name *
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
PHOTOGRAPH & PUBLICITY RELEASE
By giving my consent, I agree that Oglebay Institute may use my child's name, likeness, image, voice, and/or appearance to promote the Institute and/or its activities in uses which may include, but are not limited to illustrations, bulletins, exhibitions, videos, reprints, reproductions, and/or advertisements in any medium now known or later developed. I agree that Oglebay Institute has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with Oglebay Institute's mission.*

Yes, I consent.No, I do not consent.
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
Should be Empty:

CANCELLATIONS & REFUNDS

CAMPER HEALTH INFORMATION

EMERGENCY INFORMATION

CHILD HEALTH INFORMATION

PICK-UP AND RELEASE AUTHORIZATION

CODE OF CONDUCT

PHOTOGRAPH & PUBLICITY RELEASE