FOUR Children: Summer Camp Paperwork 2026

Before You Begin

If you are completing this form on a smartphone, please turn your device to landscape (horizontal) orientation to ensure all required fields are visible.

To complete this form, please have the following information ready:
- Emergency contact information
- Your child's immunization records
- Medication information, if applicable (including any prescription or over-the-counter medications, EpiPens, or inhalers your child may need at camp)
We would like to thank Walmart for generously sponsoring our new online paperwork platform, Jotform. Their support helps us streamline forms and improve the experience for our camp families.

Child Health Information

To help camp staff support your child’s safety and well-being. Your information is securely protected and HIPAA compliant.
- Child #1 Name*
  
  First NameLast Name
- Child's Date of Birth*
  
  MonthDayYear
- Healthcare Information*
- Does your child have a history of:
- Please list your child's allergies (if applicable):
- Please describe any health conditions checked above:
- Triggers that may cause problems:
- Signs or symptoms to watch for:
- Action steps for staff to take:
- When to call parent/guardian regarding symptoms or failure to respond to treatments:
- When to consider emergency care for child's medical condition:
- Child #2 Name*
  
  First NameLast Name
- Child's Date of Birth*
  
  MonthDayYear
- Healthcare Information*
- Does your child have a history of:
- Please list your child's allergies (if applicable):
- Please describe any health conditions checked above:
- Triggers that may cause problems:
- Signs or symptoms to watch for:
- Action steps for staff to take:
- When to call parent/guardian regarding symptoms or failure to respond to treatments:
- When to consider emergency care for child's medical condition:
- Child #3 Name*
  
  First NameLast Name
- Child's Date of Birth*
  
  MonthDayYear
- Healthcare Information*
- Does your child have a history of:
- Please list your child's allergies (if applicable):
- Please describe any health conditions checked above:
- Triggers that may cause problems:
- Signs or symptoms to watch for:
- Action steps for staff to take:
- When to call parent/guardian regarding symptoms or failure to respond to treatments:
- When to consider emergency care for child's medical condition:
- Child #4 Name*
  
  First NameLast Name
- Child's Date of Birth*
  
  MonthDayYear
- Healthcare Information*
- Does your child have a history of:
- Please list your child's allergies (if applicable):
- Please describe any health conditions checked above:
- Triggers that may cause problems:
- Signs or symptoms to watch for:
- Action steps for staff to take:
- When to call parent/guardian regarding symptoms or failure to respond to treatments:
- When to consider emergency care for child's medical condition:
- By signing, you confirm you’ve read and understand these policies*

Medication Authorization Form

Required authorization for camp staff to administer medication when necessary.
Medication Requirements:
- Prescription medications must be in the original container with the pharmacist's label marked with the prescription number, date, child's name, and physician's name.
- All non-prescription medications (OTC's) must be labeled with child's name.
- Please give all medications to camp staff upon arrival at the beginning of the week your child will be attending camp.
- All remaining medication will be returned to a parent/guardian at the end of each week. If medication is not picked-up, the Village of Bellevue will dispose of medication in an environmentally safe manner.
- If your child brings an inhaler or EpiPen to camp for emergency use, consent must be given via this form.
Is this form applicable to your children?*

YesNo
Child's Name*

First NameLast Name
Authorization is effective from *
Name of Medication*
NOTE: MEDICATION MUST BE IN ORIGINAL CONTAINER
Instructions for Administration*
Include dosage and frequency of medication administration
Parent/Guardian Signature*
Date*

MonthDayYear
Today's Date
- Child's Name
  
  First NameLast Name
- Authorization is effective from
- Name of Medication
  NOTE: MEDICATION MUST BE IN ORIGINAL CONTAINER
- Instructions for Administration
  Include dosage and frequency of medication administration
- Child's Name
  
  First NameLast Name
- Authorization is effective from
- Name of Medication
  NOTE: MEDICATION MUST BE IN ORIGINAL CONTAINER
- Instructions for Administration
  Include dosage and frequency of medication administration

Credit/Debit Card Draft Agreement

Submission of this Payment Authorization Form is required for all camp families in order for a child to attend Summer Camp 2026, regardless of whether camp fees have already been paid in full. Credit card information must be provided for our records. All credit card information is stored in a secure location and will be shredded at the end of the summer.

If you have any questions, please contact the Village Offices.

Your completed authorization must be submitted no later than May 1, 2026 by either:
- Printing the attached PDF, completing it, and dropping it off at the Village Offices (3100 Eaton Road, Bellevue, WI, 54311)
OR
- Calling the Village Offices to provide your card information by phone (920) 468-5225
Do not scan, upload, or email this form.

If this financial information is not submitted before your child’s first week of camp, your child will not be permitted to attend, even though your camp spot will be held and full weekly camp fees will still be charged.

This authorization must be received by the Village Offices before your child’s first day of camp in order for your child to participate.
Select how you will submit your payment authorization form:*

Print and drop off at the Village OfficesCall the Village Offices with my card information
Payee Signature*

I agree to submit the Payment Authorization Form using the method selected above no later than May 1, 2026.

Summer Camp Field Trip Permission Form

To be used to inform staff of registered field trips for camper.
I give my children, First Name Last Name , First Name Last Name, First Name Last Name & First Name Last Name , permission to attend the following field trip(s) checked below.
Date & Field Trip Location
Parent/Guardian Signature*

Media Release Form (Optional)

Allows the Village of Bellevue to use your child’s photo or video for promotional or informational materials.
Please list each child individually
Parent/Guardian Signature

I release the Village of Bellevue from all claims & confirm that I am at least 18 years old and legally competent to agree to this on behalf of the minor(s) listed below.

Parent & Camper Behavior Contract

Our Summer Camp program is designed to create a safe, educational, and enjoyable experience for every camper. We ask families to review and discuss our behavior expectations together. Please sign the conduct agreement included in the summer camp paperwork, as it outlines how behavior concerns will be addressed throughout the summer. Campers will also review these expectations during their first week at camp.
Parent/Guardian Signature*

I understand that by signing this contract I am obligated to follow the policies and procedures outlined in the Summer Camp Handbook.
A copy of the above Parent & Camper Behavior Contract is available for your reference on Page 19 of the 2026 Summer Camp Handbook.
Should be Empty:

Rows	Location	Before Care	After Care	Field Trip	On Waitlist	Enrolled
Week #1 Jun 8-12
Week #2 Jun 15-19
Week #3 Jun 22-26
Week #4 Jul 6-10
Week #5 Jul 13-17
Week #6 Jul 20-24
Week #7 Jul 27-31
Week #8 Aug 3-7
Week #9 Aug 10-14
Week #10 Aug 17-21 DEBROUX ONLY

Before You Begin

Family Registration Form

Family Information Form

Emergency Contacts

Authorized Pick-Ups

General Child Information

Child Accomodations

Child Accomodations

Child Accomodations

Child Accomodations

Child Health Information

Medication Authorization Form

Medication Requirements:

Immunization History

Credit/Debit Card Draft Agreement

Summer Camp Field Trip Permission Form

Alternate Arrival/Release Agreement

Arrival Instructions

Release Instructions

Media Release Form (Optional)

Parent & Camper Behavior Contract

Rows	Participant Name	Age	T-Shirt Size
Child #1
Child #2
Child #3
Child #4