Summer Camp Registration

Summer Camp Registration - Summer 2026
Thank you for your interest in the 2026 CAOWNY Summer Program!
We are excited to offer enriching summer experiences at the following community centers: Angola, Edward Saunders (ES), and JFK.

Our Edward Saunders and JFK locations will host the Say Yes Summer Camp, while the JFK location will also feature our Leadership Academy, designed for youth ages 11–14.

For program fees and cost details, please refer to the Summer Camp Fee Schedule. Proof of income and household size will be required as part of the application process.

We look forward to a fun, safe, and impactful summer with your family!

Summer Camp Fee Sheet

Individual Health Care Plan
Student's Current School
New or returning student? (Has the child ever attended summer camp?)
Choose Your Summer Camp Location:
Student Name

First NameMiddle NameLast Name
Student Date of Birth

MonthDayYear
Date
Student Age
Student Grade Level
Student Gender
Student Demographics (select all that apply):

Other
Student Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Medical Information:
Any non-medical restrictions? If yes, please specify.
Does Student have medical insurance? If yes, please specify.
Does student have any allergies? If yes, please specify.
Does Student have any serious health issues? If yes, please specify.
Does student take any medications? If yes, please specify.
Does student have any “special healthcare needs”? If yes, please specify.
Disclaimer: If a student has special health-care needs, an individual health-care plan form must be completed and submitted to the CAOWNY prior to the student’s start in the CAOWNY program.

The Individual Healthcare Plan is at the top of the page.
Parent Initials
Student Household Information:

Proof of Household Income and Size Required
Member Household Type:
Free/Reduced or Paid Lunch
Number of adults in the household:
Number of children in the household:
Language spoken in the household:
Student does not speak English:
Yearly Household Income (Select a Range):
Military Household:
If yes, list branch and current status below:
Branch
Current status:
In case of Emergency – A Minimum of Two (2) Emergency Contacts Required.

Contact Information: The CAOWNY will only release the student to the parent or legal guardian listed on this form. Individuals authorized to pick up the student may be asked to provide a picture identification. The CAOWNY must have a copy of any court orders prohibiting and/or authorizing an individual from picking up a student enrolled in programming.

Parents are responsible for updating the emergency contact list. We will not release a student to an individual not listed on this form unless written permission is given by the parent or legal guardian. NO EXCEPTIONS!
Parent Initials
Primary Contact
Name

First NameMiddle NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Contact
Name

First NameMiddle NameLast Name
Relationship to Student:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Third Contact (Optional)
Name

First NameMiddle NameLast Name
Relationship to Student

Other
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agreements
Agreement: I, the primary contact, consent to the enrollment of my child in the CAOWNY program and have been advised of the policies regarding the administration of medications, fees, transportation and services provided by CAOWNY, Buffalo Public School and Office of Child and Family Services.
Emergency: In case of accident or injury, I authorize any and all necessary emergency medical, dental, and/or surgical care and hospitalization advised by the physician, surgeon to ensure the proper health and well-being of my child.
Medical: I have provided information regarding my child’s special needs (allergies, diet, disabilities, and/or medical information). I understand this information may be required to assist the medical facility staff in properly caring for my child in the event of an emergency.
Surveys: I give consent for my child to participate in evaluation survey that will assist CAOWNY in measuring the success of the program.
Report Cards: I give consent for the CAOWNY to obtain my child’s report card, Buffalo Public Schools assessment scores during the school year.
Photo Release: I give consent for my child’s photograph to be taken and used in publications, mailings, illustrations, advertising, web content, etc. for marketing during the current school year.
Final Signatures

Please double-check above information before submitting.
Parent/Legal Guardian Name
Parent/Legal Guardian Signature
Current Date

MonthDayYear
Date
Should be Empty:

Summer Camp Registration - Summer 2026

Student Medical Information:

Student Household Information:

Primary Contact

Secondary Contact

Third Contact (Optional)

Agreements

Final Signatures