HATCC Summer Camp Main Form

Parent/Guardian #1 Information
Camper Name*

First NameLast Name
Parent's Name*

First NameLast Name
Parent's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Home Phone Number*

Area CodePhone Number
Parent's Mobile Phone Number*

Area CodePhone Number
Parent's Email*
example@example.com

Parent/Guardian #2 Information
Camper Name*

First NameLast Name
Parent/Guardian #2 Name:*

First NameLast Name
Parent/Guardian #2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Home Phone Number*

Area CodePhone Number
Parent/Guardian #2 Mobile Phone Number

Area CodePhone Number
Paren/Guardian #2 Email Address*
example@example.com

Emergency Contact Information

(These should not be the Parents/Guardian)
Camper Name*

First NameLast Name
Contact Name #1*

First NameLast Name
Contact #1 Relationship*
Contact #1 Mobile Number*

Area CodePhone Number
Contact Name #2*

First NameLast Name
Contact #2 Relationship*
Contact #2 Mobile Number*

Area CodePhone Number

Medical Information
Camper Name*

First NameLast Name
Physician Name*

First NameLast Name
Physician Phone Number*

Area CodePhone Number
Does the camper have any recurring or chronic condition(s)?*

YesNo
Please Provide details on recurring or chronic condition(s)*
Does the camper have any allergies?*

YesNo
Please Provide details on any allergies*
If there is any additional health information or special concerns about your camper that you think are important or that may impact your camper’s ability to participate in camp programs and activities, please contact a member of our staff via phone or email so we may make note of it and inform your camper’s counselors/coaches.

Waiver and Release of Liability and Consent
Camper Name*

First NameLast Name
Waiver and Release of Liability

In consideration of the acceptance of my child's, whose name islisted above, application for the above program, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Hindu American Temple And Cultural Center, hereafter known as HATCC, its officials, officers, employees, volunteers and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees.
Parental Consent

I give consent for my child to participate in the above activities, and I execute the above liability release on their behalf.
Consent for Treatment

I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that HATCC will provide no medical insurance for such treatment, and that the cost thereof will be at my expense.

Photo Release Consent For Minor Children
Camper Name*

First NameLast Name
I, a parent of the camper listed above, hereby authorize Hindu American Temple And Cultural Center, hereafter known as HATCC, to publish the photographs taken of me and/or the undersigned minor children, and our names, for use in the HATCC website and for display in the facility. I release HATCC from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize HATCC to use their photographs and names. I acknowledge that since participation in publications and websites produced by HATCC is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by HATCC confers no rights of ownership whatsoever. I release HATCC, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.

Camp Policies and Rules
Camper Name*

First NameLast Name
I, the parent of the camper listed above, understand and agree that my child(ren) must abide by the Camp policies and rules and the instructions of the Camp organizers, employees, staff, counselors, and volunteers at all times, and that my child(ren)’s failure to do so will result in his/her/their immediate dismissal from the Camp. Some of these policies, rules, and instructions are written and some are at the sole discretion of the Camp organizers, employees, staff, counselors, and volunteers; however, it is understood that all policies, rules, and instructions seek at all times to ensure the overall safety of the Camp and each of its participants.

Furthermore, should my child(ren) fail to behave in an appropriate manner, intentionally harm another participant, exhibit signs of illness, or violate any Camp policy and rule, I shall promptly retrieve my child(ren) when contacted by HATCC to do so, or, if I am unable to do so, notify HATCC of the person retrieving my child(ren) on my behalf. I acknowledge and agree that no part of the tuition paid will be refunded to me should my child(ren) be dismissed from the Camp. I also understand and agree that no reduction or prorate in the tuition will be made for late arrivals, early departures, vacations, illness, or injury

Code of Conduct for Campers
Camper Name*

First NameLast Name
Parents and Campers please read through this informational letter, which contains a set of rules for all campers to follow throughout their stay at Hindu American Temple And Cultural Center (HATCC) Summer Camp. Students are expected to adhere to these rules for the summer camp:

Campers will:

·       Participate fully in the program including all activities, classes, and workshops

·       Follow all instructors and camp counselors

·       Follow safety procedures and instructions for use of equipment during activities

·       Be respectful to camp staff and other campers

·       Be responsible for his/her own behavior and encourage peers to make appropriate choices

·       Adhere to the camp schedule including arriving on-time and being picked up on-time

Campers will not:

·       Leave the camp premises without staff/faculty supervision

·       Use or display profanity, vulgar language, or obscene gestures, words, or graphics

·       Use inappropriate language including derogatory statements

·       Steal or damage facilities or property of HATCC, staff, or campers

Failure to comply with these rules may result in expulsion from the camping program and/or you will be billed for damages. Violations in local, state or federal laws will be reported to the authorities. I also understand there are no refunds due to expulsion from the camp.

We, the undersigned camper and parent/legal guardian have read the basic rules for participation at the Hindu American Temple And Cultural Center (HATCC) Summer Camp program outlined above and agree to abide by the rules. We also understand that no refunds will be given due to missing/leaving the camp due to misconduct, sickness, or voluntary departure.

Parent Attestation and Signature
Camper Name*

First NameLast Name
Please read and check all the boxes before proceeding to the payment page.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Please sign above the line and within the box

Payment and Submit
Camper Name*

First NameLast Name
Final Registration Fees:*
Registration Fees:*

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USDHATCC Summer Camp Registration Fee
PLEASE READ BEFORE HITTING THE SUBMIT BUTTON

Once you click on the submit button, you will be taken to PayPal page to pay the Registration Fees. Please pay with Credit/Debit Card. You do not need a PayPal account to pay with your credit/debit card. After a successful completion of payment, you will come back to this form and see a Thank You page.

If you do not complete the payment on the PayPall site, your registration is not complete and you may have to come back to the form with the link you receive before and complete the payment.
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1 SESSION	BOTH SESSIONS
$200.00	$350.00

Summer Camp 2025 Main Form