2025 FP APPLICATION

EMERGENCY INFORMATION
PEDIATRICIAN*

First NameLast Name
PHONE NUMBER*
Please enter a valid phone number.
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
INSURANCE COMPANY*
INSURANCE ID NUMBER*
EMERGENCY CONTACTS

Contacted for emergency, illness, pickup if the parents/guardians cannot be reached.
Contact #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Contact #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.

MEDICAL RELEASE
In the event of an emergency I understand that the school will call me. I give my consent for trained staff to administer first aid or call 911 and have my child transported to the nearest medical facility.

Parents give permission to inform necessary camp staff of any medical needs their child may have.
Child #1*

First NameLast Name
Child #2

First NameLast Name
Name of Parent or Guardian*

First NameLast Name
Signature of parent or Guardian*

Clear

HEALTH HISTORY
NAME OF CHILD #1*

First NameLast Name
ALLERGIES. Name allergen & describe reaction/symptoms and management instructions *
NAME OF CHILD #2

First NameLast Name
ALLERGIES. Name allergen & describe reaction/symptoms and management instructions
List any current or past medical condition that would affect your child’s day.
Does your child have any dietary restrictions?
Does your child have any physical activity restrictions?
Describe any current physical, mental, or psychological conditions requiring medication, treatment, or special restrictions or considerations while in the program
MEDICAL ATTENTION OR MEDICATIONS
Does your child require special medical attention or medications such as medicine, Epi-Pen or inhaler?*

Yes (additional forms will be sent)No
SPECIAL NEEDS

Please note that we are not able to accommodate disabilities or behavior issues that require staff with special training.
Ha(ve)s your child(ren) ever been diagnosed with a developmental disability or required behavior management or support? If yes, please briefly explain.
Do(es) your child(ren) receive any special services at school, such as an aide or behavioral or learning support? If yes, please briefly explain.
Check any or all that may apply:

My child has an Individual Education Plan (IEP)My child has a Behavior Management PlanMy child has a 504 Student Accommodation Form
IF YOU CHECKED ANY OF THE ABOVE

A Camp Discovery Inclusion Form must be completed and returned with your Application Form. Enrollment will not be considered final until all required forms have been submitted.
Is there anything else about your child(ren) that you wish to share? (Any significant changes in your child's life - sickness, divorce, loss of a loved one - that currently affects them)

Insect Repellent Consent

Please fill out if applies.
CHILD #1

First NameLast Name
CHILD #2

First NameLast Name
SESSION(S) ATTENDING

Session #1Session #2Session #1 & 2
TICKS
It is almost impossible to determine where you picked up a tick as they are prevalent throughout the state of NY. Blue Rock School regularly has the grounds cedar oil sprayed to minimize exposure to ticks. However, evening tick check rituals should be part of every family’s routine through the duration of the Forest Play Program. Parents should consider applying bug spray before sending their child to Forest Play.

Children with a signed consent will be assisted by teachers to have another layer of insect repellant applied after lunch.Please be sure to mark your child’s name in permanent marker on the container. We will keep the insect repellant in your child’s classroom & send it home if it gets used up.
CONSENT

I give permission for The Forest Play Program staff to assist my child in applying the insect repellent that I will provide as needed.
Name of Parent or Guardian

First NameLast Name
Signature

Clear

Sun Protection and Sunscreen Consent

Please fill out if applies.
CHILD #1

First NameLast Name
CHILD #2

First NameLast Name
SESSION(S) ATTENDING

Session # 1Session# 2Session # 1 & 2
Wearing protective clothing, including a hat with a wide brim can help children stay comfortable in hot temperatures, we will control the intensity and duration of outdoor activities as well as allow for rest periods in shady areas. All children will be encouraged to drink extra water before, during and after outdoor play. Since it is best to apply sunscreen 30-40 minutes before going outside, please be sure to apply a first layer of sunscreen to your child before coming into Forest Play.

Children with a signed consent will be assisted by teachers to have another layer of sunscreen applied after lunch.
Please be sure to mark your child’s name in permanent marker on the container.
We will keep the sunscreen in your child’s classroom & return it when it is used up.
CONSENT

I give permission for The Forest Play Program staff to assist my child in applying the sunscreen that I will provide as needed.
Name of Parent or Guardian

First NameLast Name
Signature of Parent or Guardian

Clear

2025 FOREST PLAY SUMMER PROGRAM

CONTACT INFORMATION

ENROLLEMENT INFORMATION

BEFORE AND AFTER CARE

LATE PICK-UP

EMERGENCY INFORMATION

EMERGENCY CONTACTS

MEDICAL RELEASE

HEALTH HISTORY

MEDICAL ATTENTION OR MEDICATIONS

SPECIAL NEEDS

IF YOU CHECKED ANY OF THE ABOVE

Insect Repellent Consent

TICKS

Sun Protection and Sunscreen Consent

RELEASES AND TERMS & CONDITIONS

Injuries

QUESTIONS OR CONCERNS