2018 Summer Camp Registration K

We are so happy you have chosen The Honor Roll School's Summer of Discovery Camp for your Child!

We have an AMAZING SUMMER planned!

Once you have successfully completed this registration form, you will receive an email registration confirmation with includes links to sign up for specific weeks of camp, Specialty Camps and Extended Day.

If you have any questions about registration or need more information, please email us at cinnamon.baldwin@nlcinc.com or call us at (281) 265 - 7888.

Camper's Information

Camper's Name*

First NameLast Name

Date of Birth*

MonthDayYear

Gender*

MaleFemale

Child's T- Shirt Size

Grade in the Fall*

Is the camper a current THRS student?*

YesNo

Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Will the camper have siblings attending camp?*

YesNo

Please list the name of all siblings attending THRS camp:

Parents' Information

Parent/Guardian 1*

First NameLast Name

Gender*

MaleFemale

Cell Phone Number*

Area CodePhone Number

Home Phone Number*

Area CodePhone Number

Email*

example@example.com

Parent/Guardian 2

First NameLast Name

Gender

MaleFemale

Cell Phone Number*

Area CodePhone Number

Home Phone Number*

Area CodePhone Number

Email

example@example.com

Child in custody of: *

Both ParentsMotherFatherOther

If other, please specify:

Child lives with:*

Both ParentsMotherFatherOther

If other, please specify:

Does your child know how to swim?*

YesNo

Do you give permission for your child to swim in THRS Summer Camp programs?*

YesNo

Do you give permission for your child to attend and participate in all activities in THRS Summer Camp field trips?*

YesNo

Medical Information

Physician's Name

Phone Number

Address

Dentist/Orthodontist Name

Phone Number

Address

Medical/Hospital Insurance Carrier

Please upload a copy of your insurance card.

Does your child have allergies or other medical conditions?*

YesNo

Does your child require an Epipen? If so, please see the Coordinator of Student Activities to fill out the required authorization form.

YesNo

List ALL allergies and / or medical conditions

Operations, serious injuries, diseases, or restrictions on physical activity:

Any prescription medication that needs to be administered during camp hours must be submitted to the Coordinator of Student Activities along with the Medication Administration form. This form will be available online click here.

Behavioral concerns or problems of which camp staff should be aware:

In addition to Parent/Guardian names listed above, these persons have permission to pick up my child from Summer Camp. I understand that my child will not be allowed to leave with any person without authorization from Parent/Guardian and that the person picking up my child will need to show identification.

List all authorized person's Name, Last Name, Phone Number, Relationship to student, Driver's License #

Parent Authorization/Medical Release: The information provided is correct to the best of my knowledge, and the person described has my permission to engage in all prescribed camp activities, except if noted by me. In the case of sickness or accident, I hereby give permission to the medical personnel selected by the camp representatives to order x-rays, routine tests, treatment, dental work, and necessary transportation for the recipient at my expense. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp representative to secure and administer treatment, including hospitalization, for my child as named above. This form may be photocopied for use away from the main program site. I authorize the NLCI staff to apply sunscreen to my child’s exposed skin on an as needed basis – if child needs assistance. All photos that are taken of my child may be used for promotional purposes.

Parent/Guardian Signature.*

Date*

MonthDayYear

2019 Summer Camp Registration