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Ray of Hope Day Camp Application
July 15th, 2024 thru August 9th, 2024 Cost of camp is $1100.00 for 4 weeks. Camp is for ages 5years to 12 years. You may apply for scholarship assistance and/or DCYF subsidies for childcare. A registration fee of $75.00 is due upon registration to secure your camper's spot. ** Must fill out an application for each child.
How did you hear about our camp?
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A Note on Drop-Offs and Pick-Ups
Ray of Hope will take place at Parkview Elementary School. Located at 3030 Cornwall Drive, Bellingham, WA. Parents and guardians will need to drop off their child at Parkview Elementary by 9AM, and pick up by 5PM. Camp is held Monday through Friday each week.
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Camper Information
Camper's Name
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First Name
Last Name
Camper's Date of Birth
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Month
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Day
Year
Date
Camper's Gender
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Girl
Boy
Non-Binary/Gender Fluid
Camper's Race (select all that apply)
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Asian
Black/African-American
American Indian/Alaskan Native
White
Native Hawaiian/Pacific Islander
Camper's Ethnicity
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Hispanic
Non-Hispanic
How old is your child:
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5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
What school will the camper be attending for the 2024-2025 school year?
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Does Rebound Families have permission to take photo/video of this camper for marketing/outreach purposes?
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Yes
No
Has the camper been impacted by any of the following?
Mental Health Issues (depression, anxiety, etc.)
Substance Dependence
Experimentation with drugs and/or alcohol
Eating Disorders
Foster care and/or housing instability
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Medical Information
Does the camper have any allergies?
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Please explain on the field provided
Does the camper require an EpiPen? (if yes, please provide a description of the camper's anaphylaxis, including the description of the reaction)
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Does the camper take any medications? (is yes, please list below along with if we will need to administer at camp and any expected side effects)
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Does the camper have any dietary restrictions? (if yes, please describe below)
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Does the camper have any ongoing physical/mental conditions?
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Is the camper currently on any medications? (if yes, please list names of medications below along with dosage, if they will need to take this medication at camp, and any expected side effects)
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Please provide the details, the name of the medication and period of intake
Will the camper require any special assistance while at camp? (if yes, please describe below)
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Does the camper have any restrictions on activity? (is yes, please describe below)
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Camper's Primary Care Physician
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Primary Care Physician's Phone Number
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Area Code
Phone Number
Date of last physical exam
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Month
-
Day
Year
Date
Camper's Dentist
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Dentist's Phone Number
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Area Code
Phone Number
Date of last dental exam
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Month
-
Day
Year
Date
Medical Waiver
I hereby give permission to Ray of Hope day camp and Rebound Families staff to provide routine health care; administer medication; to order X-Rays, routine tests, treatment; to release any records necessary for me or my child. The camp has permission to obtain a copy of my child's health record from providers who treat my child and these providers may talk with the program's staff about my child's health status. I understand the information on this form will be shared on a "need to know" basis with camp staff. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Camp Director to secure and administer treatment, including hospitalization, for the camper named above. The camper described has permission to participate in all camp activities except as noted by me and/or an examining physician. This completed form may be printed for trips out of camp. I understand that if my camper requires special food needs, Ray of Hope and Rebound Families' staff will do its best to accommodate requests as specified in the form if informed 2 weeks in advance. I understand that I may need to provide additional food. By signing below, I state that all the information provided is accurate concerning my child's health and I am not withholding important information.
Parent/Guardian Signature
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Parent/Guardian Information
Parent/Guardian's Name
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First Name
Last Name
Relation to camper
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Contact Number
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Area Code
Phone Number
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency contact for camper (besides self)
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First Name
Last Name
Contact Number
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Area Code
Phone Number
Relation to camper
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Is this person authorized to pick up your child from camp?
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Yes
No
Is there anyone else that is authorized to pick up your child from camp? (if yes, please list their full name, phone number, and relation to the camper below)
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Participant Policies
Camper Policies
By signing below, you are confirming that you have reviewed our participant policies with your child, and that you both understand the expectations of participants during this camp. Failure to follow our policies may result in removal from the Ray of Hope day camp program with no refund.
Parent/Guardian Signature
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Payment
The cost of camp is $1100.00 for the four-week session. A registration fee of $75.00 will secure your camper's space with Ray of Hope day camp. Payment in full must be made by June 15th, 2024. Parents must be aware that camp will be on a first come first served basis. The registration payment enrolls the camper to the day camp program. Withdrawal of enrollment prior to the start of the camp shall deduct 20% from the full tuition amount provided to be returned to the parent/guardian. Should the camper withdraw anytime within the period of the scheduled camp session, the parent/guardian shall not receive any refund.
I agree to the above payment disclaimer
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Yes
No
Parent/Guardian Signature
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Payment Options
Please select one of the options below.
How would you like to make your $1150.00 payment?
Check (made out to "Rebound Families", and then mailed to our office at 3225 Woburn Street, Suite #220, Bellingham, WA 98226)
Venmo (@reboundfamilies)
I would like to request a scholarship (limited scholarships available. We will let you know within 1 week of application if we are able to award you a scholarship)
I would like Rebound to reach out to me about a sliding scale option
I would like Rebound to reach out to me about qualifying for the "Bring a Friend" option
Ray of Hope Day Camp Tuition Registration fee required at this time is $75.00 with full tuition $1100.00 due by June 15th, 2024. You may pay full tuition at this time.
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