Summer Camp Registration

Student Information

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact Information

The first attempt will be made to contact parents/guardians. Emergency Contacts listed below must be able to pick your child up in the event of an emergency.

Terms and Conditions of Enrollment

No student will be properly enrolled in Symone Center Summer Program without the following paperwork completed and up to date: participant application, camper health history form, medication administration form (if needed), registration fee, assumption of risk form, and payment.
No refunds will be granted if the participant leaves the program, on his/her own account or is removed from the program due to an inability to adjust or is unable to function adequately or to comply with the program rules. There is no reduction or refunds based on missed days due to absence, illness, or early withdrawal. No refunds will be given based on changes in weeks signed up for as indicated in the initial application.
A one-week camp deposit is due at the time of registration. All Weekly payments are due by Monday of the current week (no later than 9:00 AM).
For safety reasons, we must know, in advance, which children are expected to attend on any given day. If there is any change in my request for camp weeks, the site coordinator must be notified. Additionally, only the child(ren) that are enrolled will be permitted to attend the summer camp
I understand that no refunds will be given for absences.
I understand that no refunds will be given due to closure or missed days as a result of following Covid-19 safety plan, protocols, health department and CDC guidelines.
I understand that all campers and staff are recommended to wear masks during the summer program.
All late payments are subject to a $40.00 weekly late fee.
Each child will be subject to Covid-19 screening, including but not limited to screening questions and temperature checks.
Due safety and security reasons no parents or guardians will be permitted into the camp facility for any reason.
Daily screening must be completed at the time of drop off each day.
I am aware that my student must follow the rules and regulations of the summer program and may be terminated from Symone Center Summer program if he or she does not comply. 
I hereby consent to the taking of photographs, movies, Internet use, and videotapes, of my child Symone Center or its designated representatives. I also grant the right to edit, use, and re-use said products for any and all educational or public service I release any and all rights, title, and interest we or the child may have in said products. Photocopies and facsimiles of this Release and consent shall have the same legal effect as the original.

Grant Permission

Do Not Grant Permission

14. Symone Center for The Arts Summer Program is not responsible for any personal items that are lost stolen

or damaged while attending. 

15. I consent that in an emergency Symone Center may obtain medical treatment if necessary. I understand that if medical treatment is deemed necessary I will be informed as soon as possible.

16. I reviewed the application and all the information provided is accurate and true. I agree to all the terms and conditions.

17. I have received and agree to the assumption of risk form.

18. I understand that if my child is displaying any signs of illness, they will not be able to attend camp

Health Information

List any specific medical conditions or behavioral problems? Does your child have any other allergies (food, hay fever, etc)?

Yes

Are there any activities in which your child may not participate?

Yes

Are there conditions or specific needs that require special attention?

Yes

as parent/guardian, authorize Symone Center for the Arts personnel to

seek emergency treatment as required and to transport my child to the appropriate medical facility in the event that urgent/emergency care is necessary.

The information listed on this health information form is correct to the best of my knowledge, and the participant described herein has permission to engage in all prescribed program activities, except as noted on this form. 

Who is responsible for making payments?

I hereby, agree to submit summer program payments to the Symone Center for the Arts, Inc. I understand that if I pay late my account will be charged a $40.00 late fee per week/per occurrence. Additionally, non-payment may result in the termination of all services conducted by Symone Center for the Arts, Inc. I understand that I am enrolling my child for the weeks indicated in the application. I understand that I am responsible for the payment of fees for the 2023 summer program.

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Thanks for submitting! We look forward to being of service to your family!