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Child #1
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| Full Name: * |
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| Gender: * |
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| DOB: * |
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| Grade in fall: * |
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| Home school: |
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Shirt Size: *
DO NOT OVERSIZE |
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| Last tetanus shot: * |
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| Immunizations up to date: * |
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Child #2
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| Full Name: |
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| Gender: |
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| DOB: |
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| Grade in fall: |
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| Home school: |
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Shirt Size:
DO NOT OVERSIZE |
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| Last tetanus shot: |
An item with the same key has already been added. |
| Immunizations up to date: |
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Child #3
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| Full Name: |
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| Gender: |
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| DOB: |
An item with the same key has already been added. |
| Grade in fall: |
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| Home School: |
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Shirt Size:
DO NOT OVERSIZE |
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| Last tetanus shot: |
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| Immunizations up to date: |
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Child #4
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| Full Name: |
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| Gender: |
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| DOB: |
An item with the same key has already been added. |
| Grade in fall: |
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| Home School: |
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Shirt Size:
DO NOT OVERSIZE |
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| Last tetanus shot: |
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| Immunizations up to date: |
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| Camp Sessions Before/After Care |
Camp Sessions:*
(Hold down cntrl
key to select multiple
camps. |
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Do you need
early / late childcare: * |
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| Medical Information |
| Medication(s): |
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| Allergies: |
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| Medical/Physical Issues: |
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| Medical/Physical Limitations: |
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| Health Insurance Company: * |
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| Health Insurance Policy #: * |
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| Dental Insurance Company: * |
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| Dental Insurance Policy #: * |
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| Physician: * |
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| Address & Phone of physician * |
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| Dentist: * |
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| Address & Phone of dentist: * |
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| Prefered Hospital: * |
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Emergency Contact:*
Please list the name and phone number. |
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Pick up authorization: *
List anyone who is allowed to pick up your child. |
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I have read the camp rules and explained them to my child. By checking this box, my child and I agree to abide by them.
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I acknowledge that I have thoroughly read and understand the fieldtrip and transportation release. By checking this box, I grant permission to New Genesis Inc. and its staff to transport my child during camp events.
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I hereby give my consent and permission for the taking of photographs and/or video of my child for projects and future promotions.
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By checking this box, I, the legal guardian of the above named child authorize New Genesis Inc. to seek medical treatment for my child as they deem necessary. I consent to any medical or surgical treatment deemed necessary by a licensed health care provider. I understand that whenever possible, New Genesis Inc. staff will make a good faith effort to contact me or the alternative emergency contact before seeking treatment.
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Tuition & Payments
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Your tuition cost is PER SESSION. We do not have a sliding scale nor are we able to offer scholarships at this time. We have tried to make the cost of our camp very afforable for families. Your tuition includes the cost of fieldtrips, breakfast, lunch and snacks. You will not have any extra activity fees.
We do offer a sibling discount and if you are FIA eligible, FIA may cover a portion of your camp. (Please speak to your caseworker to find out what your actual cost would be.) Many of the foster care agencies also have funding available to pay for any foster children attending the camp.
Families are require to pay a one time $25.00 registration fee. Please note that FIA will NOT cover your registration fee.
Registration fees and camp tuitions are not refundable however you can transfer them to another camper.
You may pay on a weekly basis or pay all of your camp upfront. If you pay your ENTIRE tuition prior to the start of camp, you will receive the 10th week free. If you choose to pay weekly, your tuition is due the THURSDAY PRIOR to the session your child will be attending.
We will have before and aftercare chidlcare which is NOT INCLUDED in your camp tuition. The cost for before or after care is $15 per week per child for either or and $25 per week per child for both early and late care. Without after care arrangements, late charges will be assessed starting at 5:15 pm.
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