2024SMRProgramGuideFLIPPINGbook_HL

DAY CAMP INFORMATION FORM Circle the camp & days you are selecting 5 days (M-F) or 3 days (M/W/F)

CAMPER'S NAME: _________________________________________________ Grade entering in Fall 2024: ______________________ Male Female

Explorers 1st to 2nd

Explorers Breakfast Club 7 AM-8:45 AM

Explorers

Explorers Plus

Trail Blazers 3rd to 5th Session 1

Trail Blazers Breakfast Club 7 AM-8:45 AM 3 day 5 day 97088 97090 5 day 97089 97091 3 day

Trail Blazers

Trail Blazers Plus

9 AM-3 PM

9 AM-6 PM

9 AM-3 PM 3 day 5 day 97080 97084 3 day 5 day 97081 97085

9 AM-6 PM 3 day 5 day 97082 97086 3 day 5 day 97083 97087

Session 1

3 day 97076 3 day 97077

5 day 97078 5 day

3 day 5 day 97067 97072

3 day 97069 3 day 97070

5 day 97074 5 day 97075

Session 2

Session 2

3 day 97068

5 day 97073

97079

Adventurers 6th to 7th

Adventurers Breakfast Club 7 AM-8:45 AM

Adventurers

Adventurers Plus 9 AM-6 PM 3 day 5 day 97094 97099

Campalooza K to 7th

Campalooza Breakfast Club 7 AM-8:45 AM

Campalooza

Campalooza Plus 9 AM-6 PM

9 AM-3 PM 3 day 5 day 97092 97096 3 day 5 day 97093 97098

9 AM-3 PM

Session 1

Week 1

3 day 97100 3 day 97101

5 day 97102 5 day

All Week 97106 All Week 997107

All Week 997104 All Week 997105

All Week 97108 All Week 97109

Session 2

Week 2

3 day 97095

5 day 97097

97103

Camper Request for Family and Friends • Please list the first and last name of family/friends you would like to request to be in your camper's group. • Please remember that groups large than 4 will not be assigned together in order to foster the spirit of making friends. • Family/friend request must be in the same age group. • Requests are not a guarantee that campers will be together. 1. ________________________________________________________

3. ________________________________________________________

2. ________________________________________________________

4. ________________________________________________________

1. 2.

Is your child a swimmer?

Yes_____ No_____ Yes_____ No_____

Does your child take any medication (over the counter or prescribed)? If yes, please specify: _______________________________________

(Medication Form must be completed if being administered at camp.)

3. 4.

Does your child have allergies?

Yes_____ No_____

If yes, please list: _______________________________________________________

T-shirt size - Child sizes not available for Adventurers CIRCLE SIZE (T-shirt sizes are not guaranteed after May 1) Child: S (6/8) M (10/12) L (14/16) OR Adult: S M L XL

XXL

Camper’s Home Address: Father/Guardian’s Name:__________________________________________ Mother/Guardian's Name: _____________________________________ Home#: __________________________ Cell#: _______________________ Home#: _______________________ Cell#: _______________________ Business#: ____________________________________________________ Business#: _________________________________________________ If we need to contact you during Day Camp hours, who should be contacted first? (CIRCLE ONE) Father Mother Guardian In case of emergency, if parental contact is not made, please call: Name & Relationship:_____________________________________________________ Phone:( )_____________________________________ Name & Relationship:_____________________________________________________ Phone:( )_____________________________________ I give permission for my child to be transported on the bus for scheduled swim days to Centennial Park Aquatic Center and field trip destinations to be announced. If I cannot be reached or there is insufficient time to contact me, I give my consent to the Village of Orland Park Recreation and Parks Department in the event of any accident or emergency to seek and procure whatever emergency care or treatment deemed reasonably necessary at the time. I agree to the permission stated, and agree to pay medical bills arising from such treatment. My child and I agree to read the Day Camp Procedures and Discipline Policy available upon registration. We understand and agree to abide by them, plus acknowledge that the appropriate consequences will be implemented if necessary.

Parent/Guardian Signature: _______________________________________________________ Date:_____________ Staff Initial: ____________