Summer 2025 Needham Park and Recreation Camp Form

1

MyRec Account ID* This field is required.

2

MyRec Member ID* This field is required.

3

Camper's Name* This field is required.Please use name as entered on needhamprograms.com registration

First Name

Last Name

4

Camper's Birthdate* This field is required.

Date

5

Camper's Grade Fall 2025* This field is required.

6

Parent/Guardian 1* This field is required.*** Will be first contact called in an emergency***

First Name

Last Name

7

Parent/Guardian 1 Phone Number* This field is required.*** Will be first contact called in an emergency***

Please enter a valid phone number.

8

Parent/Guardian 1 Email* This field is required.

example@example.com

9

Parent/Guardian 2

First Name

Last Name

10

Parent/Guardian 2 Phone

Please enter a valid phone number.

11

Parent/Guardian 2 Email

example@example.com

12

Emergency Contact 1 - NOT A PARENT* This field is required.*** must be able to get to camp within 30 minutes to pickup child***

First Name

Last Name

13

Emergency Contact 1 Phone Number* This field is required.

Please enter a valid phone number.

14

Emergency Contact 2 - NOT A PARENT* This field is required.*** must be able to get to camp within 30 minutes to pickup child***

First Name

Last Name

15

Emergency Contact 2 Phone Number* This field is required.

Please enter a valid phone number.

16

Does your child have an epi-pen?This must be dropped off and picked up daily from camp. We cannot store them.

YESNO

18

Other allergiesLeave blank if not applicable

19

Does your child have an inhaler they will bring to camp?These must be dropped off and picked up daily. We cannot store them.

YESNO

20

Does your child have any other CURRENT medical information that our staff need to be aware of at camp?Examples include epilepsy, autism, celiac disease, add, adhd, organ transplant, etc...

YESNO

21

Describe medical concerns

22

Do you authorize Park and Recreation staff to administer sunscreen?If desired, you can apply sunscreen before camp and send sunscreen daily with your camper, counselors can help reapply. Needham Park and Recreation does not keep extra sunscreen on site.

YESNO

23

Do you authorize Park and Recreation staff to administer bug spray?If desired, you can apply bug spray to your camper before camp and send bug spray daily with your camper, counselors can help reapply. Needham Park and Recreation does not have extra bug spray available.

YESNO

24

Do you authorize Park and Recreation staff to administer ibuprofen (Motrin/Advil)?Any ibuprofen must be provided by parent or guardian.

YESNO

25

Do you authorize Park and Recreation staff to administer acetaminophen (Tylenol)?Any acetaminophen must be provided by parent or guardian.

YESNO

26

Do you authorize Park and Recreation staff to administer Benedryl (antihistamine) cream?Any antihistamine cream, including Benedryl, must be provided by parent or guardian.

YESNO

27

Do you authorize your child to be photographed by Park & Recreation staff?These photos may be used in promotional materials including, but not limited to, brochures, websites and social media pages.

YESNO

28

Is there anything else our staff may need to know about your child?Examples: ADHD, Autism, mental health concerns, recent divorce, recent move, bullying, etc...

29

Most recent health form dated after January 1, 2024* This field is required.Please upload your child's health form. This is often called a school form or camp physical form by your doctor's office, it must have a doctor's signature or say "electronically signed by provider X(doctor's name)" with date of exam. Date of exam must be within 18 months of the start of camp - January 2024 or later.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

30

Complete childhood immunization record* This field is required.Please upload your child's vaccination records - use same file as above if on one form.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

31

Medical Authorization Release Form In consideration of my child becoming a camper at the Needham Park and Recreation Summer Camp, I hereby authorize the Town of Needham or its representative to obtain emergency medical treatment on behalf of my child in the event that, in the opinion of said Town of Needham, my child is in need of any such medical treatment. I further release the Town of Needham or its representatives for any damages sustained by me in connection with providing of emergency medical treatment. The Town of Needham agrees to contact the parents or guardians as soon as is reasonably practicable after the event which requires said emergency medical treatment at the telephone number(s) indicated. The Massachusetts Camp Regulations state that camp counselors cannot put sunscreen on the campers unless written permission is given by a parent/guardian. By signing the line below, I give my permission for my child to have sunscreen applied as needed by their summer camp counselor. I further agree that I will be responsible for the payment of any case of medical treatment of any nature which may arise in connection with any sickness or accident which may occur during the period that my child is at your program, whether such expense is incurred during or subsequent to the time that my child attends your camp and will identify and hold harmless the Town of Needham for any claims for payment by providers of said medical care.

Clear

32

Participant Code of Conduct

Needham Park and Recreation is looking forward to providing all participants with a fun, memorable and safe summer. All participants have the responsibility to act in a way that can ensure a positive experience for everyone attending the programs.

Participants will be responsible for their own words and actions.
Participants will respect themselves, each other, their equipment, and their surroundings.
Participants will keep their bodies to themselves.
Participants will listen to the Park and Recreation staff and follow their instructions.
Participants will stay with their group at all times.
Participants will make an attempt to try every activity and put forward their best effort.
Participants will use appropriate language.
Participants will wear clothing and accessories appropriate for the camp environment.
Participants are responsible for any personal belongings they bring with them to camp, including electronics. Participants will use all electronics respectfully and only at the appropriate times.

33

Discipline Policy

Needham Park and Recreation staff will make every effort to follow the listed policy as written. However, some steps may be skipped depending on severity and type of behavior. Violence and threats to the safety of any and all participants and staff are never permitted or tolerated at any time.

Campers will be given up to three verbal warnings from a staff member. They may include a quick redirection or a longer conversation depending on the behavior.
The camper will be asked to sit out of an activity for a certain length of time (no longer than their age in minutes) if they have been given multiple warnings and are still continuing the behavior.
If the behavior is still occurring, staff will contact the Recreation Supervisor and the parents of the participant either at that time, or notify them at the end of the day depending upon the circumstances.
After working with parents on behavior, if it is still occurring, parents will then be asked to set up a meeting with the Recreation Supervisor and the Park and Recreation Director.
In some cases, if after the meeting there are no improvements, the camper may be removed from camp.

34

Please sign below to indicate you understand and have reviewed the Code of Conduct and Discipline Policy with the above named camper.

Clear

Participant Code of Conduct

Participants will be responsible for their own words and actions.

Participants will respect themselves, each other, their equipment, and their surroundings.

Participants will keep their bodies to themselves.

Participants will listen to the Park and Recreation staff and follow their instructions.

Participants will stay with their group at all times.

Participants will make an attempt to try every activity and put forward their best effort.

Participants will use appropriate language.

Participants will wear clothing and accessories appropriate for the camp environment.

Participants are responsible for any personal belongings they bring with them to camp, including electronics. Participants will use all electronics respectfully and only at the appropriate times.

Discipline Policy