Spring Break Camp Registration at YGP! (2025)

Camper First and Last Name:

Date of Birth:

Date

Age:

Grade:

Pronouns:

NOTE: We request this information so we can best support your child success and experience at camp.

Mailing Address:

Parent/Guardian (1) First and Last Name:

Parent/Guardian (1) Phone Number (include Cell, Home, & Work if applicable):

Parent/Guardian (1) Email:

Parent/Guardian (2) First and Last Name:

Parent/Guardian (2) Phone Number (include Cell, Home, & Work if applicable)

Parent/Guardian (2) Email:

Camp correspondence should be sent to:

The Youth Garden Project provides lunch and snacks throughout camp which are included in the registration fee. If you would like to opt out and have your camper bring their own food, please indicate below. NOTE: opting out of the provided lunches and snacks will not reduce the registration fee.

Emergency Contact #1 and Relationship to Child:

Contact #1 Phone Numbers (include Cell, Home, & Work if applicable!):

Emergency Contact #2 and Relationship to Child:

Contact #2 Phone Numbers (include Cell, Home, & Work if applicable!):

Individuals OTHER than Parents/Guardians Authorized to Pick-Up My Child; (include Cell, Home, & Work numbers if applicable):

Health Insurance Provider and Policy Number (if none, write none):

List any allergies your child has to food, medications, insects, or other- this includes any dietary restrictions. If none, write none.

List any pre-existing medical conditions your child may have. For example: asthma, hearing, earing infections, visions, fractures or sprains, diabetes, seizures, fainting spells, heart issues, etc. If none, write none.

List any regular medications your child may take. If none, write none.

NOTE: YGP staff is unable to dispense ANY medication due to our liability insurance.

We want to make Spring Break Camp as supportive and inclusive for your child as possible. Please list any behavior considerations that would be beneficial for YGP staff to know beforehand.

NOTE: We request this information so we can best support your child's success at camp. Doing so will not affect your child's eligibility for camp.

ACCOMODATION REQUEST(S): If any, please share accommodation requests that would improve your child's experience at camp.

NOTE: the Youth Programs Director may contact you to determine if YGP is able to fulfill the accommodation request and/or to discuss further how YGP could best support your child's camp experience.

PARENT GUARDIAN AUTHORIZATION: I hereby declare my child to be physically sound, having medical approval to participate in the activities of the Youth Garden Project (YGP). This health history is correct so far as I know and the person herein described has permission to engage in all prescribed activities except as noted. I further understand that neither YGP nor any of its paid staff or volunteers can be held responsible in the event of an accident.

OFF GROUNDS AUTHORIZATION: I authorize that my child has permission to go off Youth Garden Project (YGP) grounds when necessary to participate in YGP activities, as some activities require the use of a facility or recreational area that is not available to them at the garden. I agree to hold neither YGP nor any of its paid staff or volunteers responsible for any accident or injury that may occur while my child is participating in a YGP activity that is off YGP grounds.

EMERGENCY AUTHORIZATION: I authorize any representative of the Youth Garden Project to seek medical attention for my child when immediate medical care is warranted by the circumstances and I cannot be reached, or if under the circumstances there is not time to attempt to reach me because of the nature of the injury or illness. I further authorize the health care professional selected by the agency to provide the necessary care and treatment for my child.

PHOTOGRAPHY/VIDEO AUTHORIZATION: The Youth Garden Project has my permission to use photographs/videos of my child in any promotional and/or social media material.

STUDENT RELEASE: In consideration of my child's participation in the Youth Garden Project (YGP) activities, I do hereby agree to hold free from any and all liability the agency and its respective offices, employees, and members and do hereby for myself, my heirs, executors and administrators, waive, release, and forever discharge any and all rights and claims for damages which I may have or which hereinafter accrue to me arising out of or connected with my child's participation in any of the activities of YGP.

CAMP VALUES AND RESTORATIVE PRACTICES

The activities, expectations, and decisions at camp are intentional and driven by our core values of Community, Attitude, Respect, Empathy, and Safety (or C.A.R.E.S, as we like to call it). These values are connected to everything we do at camp, and we expect campers and staff to uphold these values each day in their words and actions.

Camp is all about community, and the stronger the community the better the experience. YGP staff will lead daily community building circles to help create that foundation. We also know that conflict is a natural part of any community. YGP staff are trained in restorative practices, and conflict will be met with conversation, not punishment. Campers in conflict will engage in conflict circles, where they will learn to work through conflict as it arises, expressing what they feel and what they need to move forward at camp. Campers coming to YGP agree to engage in these restorative practices while a part of our camp community. YGP also uses Positive Behavior Interventions & Supports (PBIS), which is a district and state supported behavior program also utilized at Helen M. Knight Elementary (HMK), to proactively teach and reinforce our values and expectations to all campers.

Ultimately, camp needs to be a safe and inclusive space for everyone. If a conflict ever becomes a safety concern, the Youth Programs Director will work with the families involved to determine the best course of action to keep everyone in our camp community safe. We reserve the right to require an adult to come pick up a camper whose behavior is posing risks to the safety and wellbeing of themselves or others, or is interfering with camp operations.

If a camper is barred from camp due to a safety concern, camp tuition will not be refunded for the remainder of the day or week. Deposits and payments made toward future weeks will only be refunded if the decision to bar the child from camp is made 30 days prior to the camp start date or if we are able to fill the child's spot.

I have read, understand, and agree to work with my camper to honor YGP's camp values and to engage in restorative practices while at camp, including community building and conflict circles:

PAYMENT INFORMATION

Cost for camp is $260 for the entire week; however, we have a sliding scale rate of either $65/$135/$195 per child per session for qualifying families who apply for tuition assistance.
The $260 payment (which includes the $45 good faith deposit) is due after you submit this registration form and recieve a confirmation email, with the exception of those applying for tuition assistance. To pay online, we will send you a payment link and a confirmation email after recieving the registration form. Cash or check payments can be mailed to the Youth Garden Project (530 Fourth E St) or dropped off in person.
If you are applying for tuition assistance, please submit the application at the same time as registration. We will be in touch the week of March 24th (or sooner) regarding your tuition assistance amount. Payment for camp will be due by the first day of camp.
If you need to cancel registration for any reason, a refund will be contingent upon YGP's ability to fill your campers spot.
If we DO NOT recieve your full camp payment by April 7th, 2025 your campers spot will be offered to the next person on the waitlist.
Payment plans are available, a plan must be made with the Youth Programs Director by March 31st to hold your campers spot.

I have read through, understand, and agree to all of the information shared throughout the 2025 Spring Break Camp registration form:

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Spring Break Camp Good Faith Deposit

This deposit will reserve your campers spot and will go towards the overall cost of camp.

$45.00 Quantity
Item subtotal:

Spring Break Camp Full Deposit

This deposit in addition to the good faith deposit will cover your full cost of camp for one child. If you choose to not make this payment now, an invoice will be sent to you from our Youth Programs Director to be paid by March 31st.

$215.00 Quantity

Total

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Spring Break Camp Registration at YGP! (2025)

General Information

Emergency Contact Information

Allergy & Medical Information

Parental/Guardian Releases

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