ENGLISH - KIWANIS OF LITTLE HAVANA FOUNDATION HEALTHY KIDS SUMMER CAMP 2026 SLAM Miami

KIWANIS OF LITTLE HAVANA FOUNDATION HEALTHY KIDS SUMMER CAMP 2026 SLAM Miami – 542 NW 12thAve June 8th-July 31st, 2026 8:00 AM – 4:00 PM Registration & Eligibility Intake

Register your family for the FREE 8-week Kiwanis of Little Havana Foundation Healthy Kids Summer Camp and complete household eligibility, emergency, and waiver requirements.
IMPORTANT NOTICE

REGISTRATION AT SLAM MIAMI FOR ALL PARENTS/GUARDIANS:

Tuesday, May 19th, 2026

Incomplete applications will not be accepted. Parents who do not submit all the required documents will have their application returned and will need to re-submit.
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Registration Information

Place:

SLAM Miami

542 N.W. 12 Ave,

Miami, FL 33136

Slam 2 Cafeteria

                Date:                     Tuesday, May 19th, 2026

                Time:                     4:30pm – 6:30pm

NO EXCEPTIONS! STRICTLY ENFORCED!

Required Documents
- Completed Application (included)
- Emergency Contact Form (included)
- Kiwanis Liability Waiver (included)
- Lice Policy Notice (included)
- Intake Form
- Supporting documents* (must be uploaded)
- Copy of Birth Certificate for each camper (must be uploaded)
- Copy of photo ID of at least one parent (must be uploaded)
- Copy of 2025 Taxes (or most recent) (must be uploaded)
- Proof of government assistance (if applicable) (must be uploaded)
Incomplete applications will not be accepted. If the required documents are not submitted, the child will not be allowed in the camp.
Parent/Guardian Information
Mother/Guardian Full Name

First NameLast Name
Father/Guardian Full Name

First NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Vacation Dates (if any)
Total Gross Family Income ($)
Camper Information (Up to 4 Children)
Camper Information
Parent/Guardian Certification
We certify that we are the parents/guardian of the children stated on this form authorize our children/child to participate in the Kiwanis of Little Havana Foundation and we forever indemnify and release the Kiwanis of Little Havana Foundation and any individuals or entities associated or subcontracting with the sports camp from any liability for any and all injury and/or sickness suffered by our children/child arising out of his/her participation in this program. The Camp Directors reserve the right to suspend or expel any campers for any reason they should see fit.
Signature of Mother/Guardian
Date (Mother/Guardian)

MonthDayYear
Date
Signature of Father/Guardian
Date (Father/Guardian)

MonthDayYear
Date

Emergency Contact & Medical Info
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Camper Emergency Medical Info
*IMPORTANT NOTE: AT THIS TIME, OUR SUMMER CAMP PROGRAM IS NOT EQUIPPED WITH THE SPECIALIZED STAFF OR FACILITIES REQUIRED TO SUPPORT CHILDREN WITH SPECIAL NEEDS WHO REQUIRE ADDITIONAL MEDICAL, BEHAVIORAL, ONE-ON-ONE ASSISTANCE, OR ELSE. WE ARE ALSO UNABLE TO ACCOMMODATE EXTERNAL AIDES, THERAPISTS, OR MEDICAL/NON-MEDICAL SUPPORT PERSONNEL DURING CAMP HOURS.
Authorized Pickup Persons (Up to 3 additional persons)
Print Full Name

First NameLast Name
Parent/Guardian Signature (Emergency Contact)
Date (Emergency Contact)

MonthDayYear
Date

WAIVER AND RELEASE OF LIABILITY
This Waiver and Release of Liability; Indemnification and Hold Harmless Agreement (the “Agreement”) contains important information and provides for the release of significant legal rights related to participation by the Camper/Participant identified above in the KIWANIS OF LITTLE HAVANA FOUNDATION HEALTHY KIDS SUMMER CAMP (“Summer Camp”) operated by KIWANIS OF LITTLE HAVANA FOUNDATION in Miami, Florida. The term “Camper” or “Participant” refers to the participant in Summer Camp activities and includes children in participating in the Summer Camp Program. By executing this document the undersigned (i) agree to Camper’s participation in the Summer Camp; (ii) acknowledge that Summer Camp involves a risk of injury to Camper; and (iii) agree to the limited release and indemnification provisions, all as more fully set forth below. The undersigned agree to all of this in exchange for KIWANIS OF LITTLE HAVANA FOUNDATION’S agreement to allow Camper to participate at no cost in the Summer Camp. This Agreement binds all parties who have executed this agreement, including the Camper/Participant, as well as Camper’s Parent(s) and/or Legal Guardian(s).

PLEASE REVIEW THE PROVISIONS BELOW CAREFULLY AS THEY INCLUDE IMPORTANT DETAILED INFORMATION REGARDING THE PROVISIONS OF THIS DOCUMENT.

1)      Acknowledgement of Risk. Camper, Parent(s) and/or Legal Guardian(s) acknowledge and fully understand that there are inherent risks of serious injury or death associated with Summer Camp activities. Camper, Parent(s) and/or legal Guardian(s) further acknowledge that there may be other sources of risks at the Summer Camp which may include activities conducted away from the Summer Camp location (“Off-site Activities”). These may include trips to museums, amusement parks and other similar activities. The KIWANIS OF LITTLE HAVANA FOUNDATION may arrange for bus, van or private car transportation to facilitate such activities and I authorize Camper’s participation in such off-site activities, including transportation to and from such activities by whatever means are deemed reasonable and appropriate by the KIWANIS OF LITTLE HAVANA FOUNDATION.

2)      Camper Waiver of Rights and Release of Liability. Camper, Parent(s) and/or Legal Guardian(s) hereby release, waive and discharge the KIWANIS OF LITTLE HAVANA FOUNDATION, its agents, employees, and volunteers from all loss damage, injury, or liability arising in connection the Summer Camp including all Summer Camp activities, use of Summer Camp facilities and equipment. This waiver extends to, but is not limited to those risks described in paragraph #1 above.

3)      Indemnification and Hold Harmless. Camper, Parent(s) and/or Legal Guardian(s) further agree to indemnify and hold harmless the KIWANIS OF LITTLE HAVANA FOUNDATION, its agents, employees and volunteers, from and against all losses, damages, monetary awards and expenses, including all costs and attorney’s fees incurred by the indemnified parties in connection with any and all claims asserted against the KIWANIS OF LITTLE HAVANA FOUNDATION, its agents, employees or volunteers, brought by Camper, Parent(s) and/or Legal Guardian(s), and their respective heirs successors, assigns and legal representatives for any injury, illness, disease death, or damage to or loss of property, arising in connection with Summer Camp.

4)      Photographs and Audio/Digital Recordings. Camper, Parent(s) and/or Legal Guardian(s) further grant to the KIWANIS OF LITTLE HAVANA FOUNDATION & KIWANIS CLUB OF LITTLE HAVANA the right to take photographs and audio/digital recordings of him or her while participating in any activities during the Summer Camp and authorizes the KIWANIS CLUB OF LITTLE HAVANA & KIWANIS OF LITTLE HAVANA FOUNDATION, its agents, employees and volunteers, to copyright, use and publish the photographs in print or electronically. The undersigned further agree that the KIWANIS CLUB OF LITTLE HAVANA & KIWANIS OF LITTLE HAVANA FOUNDATION may use such photographs for any lawful purpose including publicity, illustration, advertising, and website content and waive any right of compensation or ownership thereto. Your child’s name or any other personal information will not be disclosed with the photograph.

5)      Miscellaneous. The parties agree that the provisions of this Agreement shall be deemed severable and that the invalidity or unenforceability of any one or more of the provisions of clauses hereof shall not affect the validity and enforceability of the other provision or clauses hereof except as specifically set forth herein. The terms of this Agreement constitute the entire agreement and

I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the KIWANIS CLUB OF LITTLE HAVANA & KIWANIS OF LITTLE HAVANA FOUNDATION, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and holds harmless the KIWANIS CLUB OF LITTLE HAVANA & KIWANIS OF LITTLE HAVANA FOUNDATION, from any and all liabilities incident to my minor child’s involvement or participation in these events and activities associated with the KIWANIS CLUB OF LITTLE HAVANA & KIWANIS OF LITTLE HAVANA FOUNDATION HEALTH KIDS SUMMER CAMP. I certify that I have read this agreement and that I understand that I am giving up substantial rights and assuming substantial responsibilities by signing it, and that I sign it freely and voluntarily without any inducement.
Camper Waiver Acknowledgment (enter information of each participating camper)
Custodial Parent/Guardian

First NameLast Name
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Waiver and Release of Liability
Name of Parent/Guardian (Minor Participants)

First NameLast Name
Parent/Guardian Signature (Minor Participants)
Date Signed (Parent/Guardian)

MonthDayYear
Date
Emergency Phone Number (Waiver)
Please enter a valid phone number.Format: (000) 000-0000.

SUMMER CAMP INFORMATION RULES & REGULATIONS

(Please read carefully & keep for frequent review)
1.     Drop Off & Pick Up: Children will be allowed to be picked up only by authorized persons. Please fill out the names of the authorized persons to pick up your child from camp in the emergency contact form. YOU MUST SIGN IN & SIGN OUT your child daily. Any child not signed in/out will be assumed absent. 4pm pickup is strictly enforced. After 4pm, $5 will be charged for every 30 minutes a child has not been picked up.

2.     Field Trips: For your child to participate in field trips, you must sign and immediately return the authorization form sent home with your child. Your child will not be able to participate in field trips without a signed authorization form. If you do not wish for your child to attend the field trip, do not send your child to camp on that day as there will be no supervision staying behind at the site on field trip days.

3.     No Electronics: Mark your child’s belongings with their name but know that the KIWANIS HEALTHY KIDS SUMMER CAMP COUNSELORS WILL NOT BE RESPONSIBLE FOR LOST ITEMS.

4.     Uniforms: Campers must wear camp uniform daily and will not be admitted to camp without uniform. Shorts must be of appropriate length – NO DROPPED PANTS. No open-toed shoes (sandals).

5.     Discipline: Campers are expected to be respectful and behave well. He/she must follow all the rules of the counselors. The camp counselors reserve the right to suspend a child for disciplinary reasons or repeated offenses.

6.     Attendance: Campers must attend daily. All absences must be notified and excused to the camp/Kiwanis office. Frequent absenteeism, 3 or more unnotified & unexcused absences in one week, will result in termination from the summer camp. There is a wait list for children to attend camp who will be given the opportunity if your child is absent frequently. All vacation time must be communicated to your child’s counselor before taking their time off.

7.     Hours of Operations: Summer Camp will operate strictly from 8 a.m. to 4 p.m.
I certify that I have read, understand, and accept the Kiwanis of Little Havana Foundation Summer Camp Rules and Regulations.
Print Full Name (parent)

First NameLast Name
Signature

Lice Policy Acknowledgment
As we strive to provide a safe and healthy environment for all our campers, we would like to take a moment to inform you about our lice policy, which is based on the guidelines established by the Miami Dade County Public Schools.

Lice, also known as head lice, are a common issue that can affect children of all ages. To prevent the spread of lice among campers, we kindly request your cooperation in following the guidelines outlined below:

Prevention Measures:

a. Teach your child to avoid head-to-head contact with others, as lice are typically transmitted through direct hair-to-hair contact.

b. Instruct your child not to share personal items such as hats, combs, brushes, hair accessories, headphones, or towels with other campers.

Regular Checks:

a. We encourage you to check your child's hair regularly for signs of lice, including persistent itching, redness on the scalp or neck, or the presence of nits (lice eggs) attached to the hair shafts.

b. If you detect any signs of lice, please notify us immediately so that we can take appropriate action and provide guidance.

Confidentiality and Privacy:

a. We understand that lice infestations can be sensitive matters, and we assure you that all reports will be handled with utmost confidentiality and respect.

Treatment and Return to Camp:

a. If your child is found to have lice, we kindly request that you treat the infestation promptly.

b. Once the treatment is complete, please provide us with a note from a healthcare professional stating that your child is lice-free and can safely return to camp.

The Kiwanis of Little Havana Foundation Healthy Kids Summer Camp reserves the right to conduct head lice checks as needed throughout the duration of the camp, starting with an initial check on the first week of camp.

In the event that a camper is found to have an active lice infestation, we kindly request that they are immediately removed from camp to prevent the spread of lice to other campers. To ensure the health and well-being of all participants, the affected camper will not be permitted to return to camp until they have been effectively treated and declared lice-free by a healthcare professional. We understand that this may cause inconvenience, but it is essential to maintain a lice-free environment for the safety and comfort of all campers. We appreciate your understanding and cooperation in adhering to this policy.

Thank you for your attention, and we look forward to a fantastic summer at Kiwanis of Little Havana Foundation Summer Camp!
I certify that I have read and understand the Kiwanis of Little Havana Foundation Summer Camp Lice Policy and agree to comply.
Print Full Name (parent)

First NameLast Name
Parent/Guardian Signature (Lice Policy)

Eligibility & Household Intake
INSTRUCTIONS

To qualify for the KLHF programs/projects, you are required to provide updated information regarding your income, assets deductions, and family circumstances. Please carefully read and complete the attached packet according to the following instructions:

1.      Complete the attached Application for Initial Eligibility.

·         Read each question carefully and provide an answer or the requested information.

·         Provide your family composition and answer Yes or No to each question.

·         Read the instructions carefully after you answer Yes to any question. Instructions can be found above or below the question.

2.      Gather the following documents and present them to the KLHF Office.

IMPORTANT: All documents must be authentic, legible, and current.

        Photo identification for adult labeled head of household.

        Latest tax returns and/or two (2) current and consecutive paycheck stubs for adult labeled head of household.

        Current Statement from all sources of income including but not limited to:

       TANF assistance, (food stamps, cash assistance, etc.)

       Social Security Income.

       Unemployment.

3.      You and all household members aged 18 and older must sign the following documents:

·         Page 4, Certification Statement, Authorization of Release of Information, and General Consent.

4.      A KLHF staff member or volunteer will check your packet and documents at registration. If more information is needed, please send it quickly to avoid delays. Once you're approved for the program, you'll get an acceptance letter by email.

5.      The information collected by this intake form is necessary for the Kiwanis of Little Havana Foundation to acquire funding for various sources.
Date (Eligibility Intake)

MonthDayYear
Date
Head of Household Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone (Head of Household)
Please enter a valid phone number.Format: (000) 000-0000.
Email (Head of Household)
example@example.com
Household Members (including children) (Up to 6)
Income Information
Earned income includes employment and wages of any kind (full-time, part time, seasonal, self-employment, temporary employment, or cash payments). If you work at a temp agency, list below and estimate your pay.
Does any household member receive earned income?
VERIFICATION: Provide two (2) current and consecutive paystubs, a payroll print-out/summary, or employer letter (on letterhead) dated with 60 days; for self-employed, provide a copy of your most recent tax return (1040, 1040A) or a Profit and Loss statement dated within 60 days
Earned Income Details
Earned Income Details
Other Income Sources (Check all that apply)
If yes, indicate the type, source and amount of income for each household member in the spaces below and submit statement(s) dated with the last 60 days for each source of income:
Other Income Details
Certification, Authorization & Consent
I certify and consent to the following:

1.       The information provided to Kiwanis of Little Havana Foundation regarding household composition and income is accurate and complete to the best of my knowledge and belief.

2.       I understand that this information will be used by the Kiwanis of Little Havana Foundation to verify my initial or continued eligibility and level of benefits.

3.       I understand that this information is protected by law and cannot be released/request without my written consent unless otherwise provided by law. I further understand that this consent may be revoked by me, in writing at any time, except if the information has already been released or obtained.

4.       I hereby authorize and release my information to be used/released by the Kiwanis of Little Havana Foundation for purposes of acquiring funding from various sources.
Head of Household Name (Certification)

First NameLast Name
Head of Household Signature
Date (Certification)

MonthDayYear
Date
Spouse/Co-Head Name (Certification)

First NameLast Name
Spouse/Co-Head Signature
Date (Spouse/Co-Head Certification)

MonthDayYear
Date
Other Adult Household Member Name (Certification)

First NameLast Name
Other Adult Household Member Signature
Date (Other Adult Certification)

MonthDayYear
Date

Document Upload

If you cannot upload the documents, you may email them or bring them to the Kiwanis Office in Person Email: Reception@kiwanislittlehavana.org Address: 1400 SW 1st Street Miami, FL 33135
Required Documents:
- Copy of Birth Certificate (for each camper)
- Copy of photo ID of at least one parent
- Copy of 2025 Taxes (or most recent)
- Proof of government assistance (if applicable)
Applications without required documents will not be accepted!
File Upload

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KIWANIS OF LITTLE HAVANA FOUNDATION HEALTHY KIDS SUMMER CAMP 2026 SLAM Miami – 542 NW 12thAve June 8th-July 31st, 2026 8:00 AM – 4:00 PM Registration & Eligibility Intake

Parent/Guardian Information

Camper Information (Up to 4 Children)

Parent/Guardian Certification

Emergency Contact & Medical Info

WAIVER AND RELEASE OF LIABILITY

SUMMER CAMP INFORMATION RULES & REGULATIONS

Lice Policy Acknowledgment

Eligibility & Household Intake

Income Information

Certification, Authorization & Consent

Document Upload