K-8 Summer Camp 2026 Application

Health Assessment and Immunization Record Upload

We need a health assessment on file for all children you are enrolling in program. If your child is currently enrolled in our 2025-2026 school year program, we have it. If not, you will need to provide a health assessment and immunization records for your child(ren) that was completed in the past 12 months. Please upload below. They cannot begin camp without it.
Upload Health Assessments Here

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Emergency Contact / Parental Consent Form

Please read carefully and fill out all Emergency Contact, Authorized Release, and Parental Consent questions to indicate your consent.
Emergency Contact Persons

Please provide emergency contacts that are IN ADDITION TO parents/guardians listed above.
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 3

First NameLast Name
Emergency Contact 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Release

Please provide at least 2 persons to whom your child can be released IN ADDITION TO a parent/guardian listed above.
Authorized Release 1 Name*

First NameLast Name
Authorized Release 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Release 1 Email Address*
example@example.com
Authorized Release 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Release 2 Name*

First NameLast Name
Authorized Release 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Release 2 Email Address*
example@example.com
Authorized Release 2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Release 3 Name

First NameLast Name
Authorized Release 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Release 3 Email Address
example@example.com
Authorized Release 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please sign to give consent for your child to receive emergency medical care if needed.*
In case of a medical emergency, I understand that my child will be transported to the hospital as the local emergency resource (police, EMS, fire, etc.) deem necessary.*
In hereby assume full financial responsibility for any medical attention or treatment provided, as well as transport.*
It is understood that in some medical emergencies, staff will need to contact the local emergency resource before contacting the parent, child's physician, and/or other adults acting on the parent's behalf.*
Please sign to give consent for your child to receive the administration of minor first-aid procedures.*

Field Trips/Water Play

In order for your child to attend trips and participate in water play, we require parent/guardian permission. We are not authorized to offer swimming, only water play activities (wading pools, water sprays, slip n' slides, etc.)
Please sign to give consent for your child to go on all summer field trips with program staff. We will provide detailed field trip list prior to the start of camp.*

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Please sign to give consent for your child to go on walks with program staff. *

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Please sign to give consent for your child to be transported by the facility. *

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I hereby authorize HLCCTL K-8 Program to transport my child to and from the Honickman for field trips by Van, Bus, or Walking. *
Water Play (wading) activities will be offered on-site during the summer. Please sign to give consent for your child to go wading.*

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I release HLCCTL, K-8 Program, Project HOME and/or any of their agents or employees from all claims, demands, judgements, for all personal injuries known and unknown which my child has or may incur by participating in water play activities. *
Sanitizer & Topical Ointments
I understand that my child will utilize hand sanitizer in their classroom and other areas of the building and/or while on trips.*
I understand that my child will utilize sun screen and/or insect repellant while engaging in outdoor play, water play, and/or on trips.*
Parent/Guardian Responsibilities
I understand that HLCCTL reserves the right to refuse participation in the program. Poor behavior, disrespect, any act of violence, stealing, use of profanity, etc. may prevent my child/children from participating in activities.*

Project HOME Image Release Form
Definition of “Personal Image”
In this form, “Personal Image” means any:
• photograph, film, video, sound recording, or drawing that depicts the image, likeness or voice of my child; or
• any edited or modified version of the above; or
• my child’s name

Grant Project HOME Right to Use Personal Image
I, on behalf of my minor children, grant to Project HOME the right and license to use, copy, modify and display the Personal Image in any medium (example- written or electronic) for its promotional or operational efforts.

Types of Uses by Project HOME
This right includes the right to use my child’s Personal Image in Project HOME’s:
• newsletter, mailings, promotional and fundraising materials, paper or electronic publications, web pages, social media and networking sites, films, videos, and other similar works.

No Compensation
I understand that neither I, nor my minor children, will receive any money or other compensation for use of any Personal Image.

No Right to Approve use or Personal Image
I understand that neither I, nor my minor children, will have the right to inspect or approve any Personal Image or any edited or modified version of any Personal Image.

Waiver and Release of Any Liability
I, on behalf of my minor children, hereby release and hold harmless Project HOME and its agents and employees from and against any claims related to the use of any Personal Image, such as any editing, blurring, or alteration, either intentionally or otherwise, that may occur in its publication or distribution.

Right in Perpetuity
I understand that this right continues unless I change my permissions in writing to the Program Manager, or Building Direcor, or the Development at Project HOME.
I have read this form, and I fully understand its meaning and effect, and I:*
Your Signature*

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Biometrics - Security Camera Consent
This Security Camera Consent (this “Consent”) is by and between Project HOME and its affiliates (collectively “Project HOME”) and the undersigned.

By signing this Consent, I understand and agree that Project HOME utilizes a cloud-based security system with facial recognition software provided by a third-party vendor for purposes of verifying identity and securing and controlling access to our buildings (the “Security Cameras”). The Security Cameras leverage algorithmic systems that may collect, capture, or otherwise acquire certain information about facial geometry, or other bodily features, that constitute biometric data or identifiers under some laws or regulations.

I expressly agree that the Security Cameras may collect and process your information, including any facial geometry or other biometric data, so that Project HOME may secure and control access to its buildings; ensure the safety of its inhabitants and personnel; prevent and deter theft; investigate any incidents, unauthorized access, or other issues; and as otherwise necessary and appropriate. I further agree that the vendor of the Security Cameras may use your information to train the algorithms and software used to power the Security Camera. I further agree to the terms of Project HOME’s Privacy Policy.
I, First Name* Last Name* (full name of parent/legal guardian ), have legal custody of the child(ren) listed below and consent to the collection, processing, storage, and disclosure their data in accordance with the terms set out above.
Child 1 Name *

First NameLast Name
Child 2 Name

First NameLast Name
Child 3 Name

First NameLast Name
I have read this form, and I fully understand its meaning and effect, and I:*
Your Signature*

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2026 Summer Camp Registration/ Emergency Contact and Parental Consent Form

Please hit submit to complete the Emergency Contact/Parental Consent form.
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

K-8 Summer Camp 2026 Application

Parent/Guardian Information

Student Information

Student Information

Student Information

Health Assessment and Immunization Record Upload

Emergency Contact / Parental Consent Form

Emergency Contact Persons

Authorized Release

Field Trips/Water Play

Sanitizer & Topical Ointments

Parent/Guardian Responsibilities

Project HOME Image Release Form

Biometrics - Security Camera Consent

2026 Summer Camp Registration/ Emergency Contact and Parental Consent Form