• KAMPER REGISTRATION FORM

  • KAMPER INFORMATION

  • BIRTHDAY
     - -

  • HOUSEHOLD

  • Format: (000) 000-0000.
  • Custody
  • Format: (000) 000-0000.

  • PICK-UP AUTHORIZATION

    List all individuals authorized to pick up your child, including their name, relationship, and contact number.

  • ADDITIONAL INFORMATION

  •
  • 2 SHIRTS INCLUDED. ADDITIONAL SHIRTS AVAILABLE FOR $23 EACH.
  • CAN HAVE SODA AND/OR CANDY?

  • TERMS OF AGREEMENT

    • This enrollment is not valid unless signed by a parent or guardian.
    • Due to the seasonal nature of summer camping and the set limitation on spaces offered, no refunds, should be provided for absences, changes, withdrawals, or dismissal for cause after the day before the opening day of kamp. Similarly, in the unlikely event that kamp should be closed for reasons out the Kamp or Club’s control, such as severe weather or power outages, no refunds or credits will be provided.
    • For the safety and general welfare of all kampers, the Camp reserves the right to dismiss a kamper whose conduct or influence, in the opinion of the director, is detrimental to the best interests of the Kamp.
    • Kamp and the Club at which the Kamp is being held (Kenwood Country Club) is not responsible for the loss of clothing, equipment, or other personal belongings.
    • Kamp and the Club reserve the right to use photographs/videos of campers for promotional purposes, and the Parent/Guardian authorizes such use without compensation.
    • With this application, permission is granted for the enrolled kamper to participate in all activities including swimming, and transportation within the Club property by golf cart if and when necessary.
    • I hereby give permission to take my child to any hospital facility or outside doctor when deemed necessary. Furthermore, I hereby give permission to such hospital or outside doctor to authorize ex-rays and emergency treatment if deemed necessary. I understand that all medical bills are my responsibility.
    • Participation in any activities and use of any recreational facilities involves a risk of accidental injury despite all safety precautions, I as parent or guardian of the participant named herein, assume all risks and hazards incidental to the activities and release from responsibility and agree to indemnify and hold harmless damage, illness or injury to me or my children or family members occurring during his/her participation in or in any way connected to the kamp or to any kamp activities or trips including all losses, damages, illnesses or injuries arising from the released persons negligence, the design of the facility and/or equipment, or from any third party.
    • With this application, permission is granted for the Club to email me regarding kamp-relate information.

    I have read the Terms of Agreement above and understand their terms and accept their conditions. In the event that one parent executes this Agreement, I acknowledge that I am also acting as the agent of the other parent with authority to enroll my child at a Kamp and to execute this agreement upon the representations herein made in accepting this enrollment.

  • TODAY'S DATE
     - -

  • NINE WEEKLY SESSIONS

    Please select the week(s) and Kamp option(s) for your child. Choose one option per week.
  • WEEK 1: JUNE 1-5
  • WEEK 2: JUNE 8-12
  • WEEK 3: JUNE 15-19
  • WEEK 4: JUNE 22-26
  • WEEK 5: JUNE 29 - JULY 3
  • WEEK 6: JULY 6-10
  • WEEK 7: JULY 13-17
  • WEEK 8: JULY 20-24
  • WEEK 9: JULY 27-31
  • SWIM TEAM PARTICIPATION? (Note: Counselors will transport to/from daily.)

  • HEALTH SECTION

  • DOES YOUR CHILD REQUIRE AN EPI-PEN?

  • ALLERGIES

  • DIETARY RESTRICTIONS

  • DOES YOUR CHILD HAVE ANY DIETARY RESTRICTIONS?

  • MEDICAL CONDITIONS

  • Rows
  • DOES YOUR CHILD HAVE ANY RESTRICTIONS ON ACTIVITY?
  • WILL YOUR CHILD REQUIRE ANY SPECIAL ASSISTANCE WHILE AT KAMP?

  • HEALTH INSURANCE

  • DO YOU HAVE MEDICAL INSURANCE?

  • MEDICAL PERMISSION STATEMENT

    The health information I have provided is correct and complete. My child has permission to engage in all kamp activities except as noted on this heath form. I hereby give permission to Kenwood Country Club to provide routine health care, administer prescribed medications, and seek emergency medical treatment including hospitalizations., x-rays or routine tests. I consent to have my child use the sunscreen she/he has brought, or the kamp has supplied, which is approved by the FDA for over-the- counter use to avoid overexposure to the sun. I consent to have my child use the bug spray she/he has brought. My child may be assisted by camp staff if she/he requests or as needed. I agree to the release of any records necessary for insurance purposes. I give permission to the camp to arrange necessary emergency related transportation for my child.

  • Date
     - -

  • AUTHORIZATION TO ADMINISTER MEDICATION

    To be completed by Parent/Guardian only if Kamper needs medication during the kamp day.
  • Date
     - -

  • MEDICATION INFORMATION

  • I REQUEST THAT MY CHILD BE ASSISTED IN TAKING THE MEDICINE(S) DESCRIBED BELOW AT KAMP BY KENWOOD KAMP STAFF.

  • MEDICATION FORM
  • Date
     - -
  • Should be Empty: