Summer Camp Registration

Blessed Sacrament Church
Summer Camp
“Our Children are the Future”

Summer Camp is a four-week program that offers a well-supervised and organized summer camp experience for our youth. Daily activities at the camp include arts and crafts, outdoor, fun and games. A variety of fun, educational components will be incorporated to promote unity and teamwork, safety and environmental stewardship. Campers also go on a variety of field trips. In the past, these have included Quassy, Beardsley Zoo, CT Science Center, and Lake Compounce Amusement Park, to name a few. We are going to have a blast. Be sure to get in on the Fun! Summer Camp will begin on Monday, July 6, 2020, and conclude on Friday, July 31, 2020.

GENERAL INFORMATION
•    Summer Camp Begins at 9:00 am and ends at 3:00 pm. (* Field trips may arrive back later.)
•    All Parents must sign-in your child(ren) each day.
•    Breakfast is served from 9:15am.
•    Lunch is served from 12:15pm.
•    All Camp Payments (including trip fees) must be made on or before Monday of the payment week.
•    Designated adults will administer medications.
•    Designated adults will administer first-aid.
•    Children will be released to persons designated on registration forms. 
•    Proper ID must be supplied or child will not be released.

Pay in full $350 IN TOTAL ** ...That is less than $88.00 a week

includes t-shirt, trips, transportation, breakfast, lunch, snack & lots of fun

REGISTRATION FOR CAMP BEGINS MAY 1st

•    REGISTRATION IS TAKEN ON A FIRST-COME FIRST-SERVE BASIS.

•    AN UPDATED COPY OF THE MOST RECENT MEDICAL CARD IS REQUIRED FOR REGISTRATION.

•    Camp Fee includes t-shirt, trips, transportation, breakfast, lunch & snack & lots of fun

*     Sibling Discounts

INFORMED CONSENT
Message I hereby attest that I have been informed of the following pertaining to the coronavirus:______________________________________________________________ o People who are 65 years and older and people of any age who have serious underlying medical conditions or are at higher risk for severe illness from COVID-19 are recommended to stay at home. A list of medical conditions associated with a higher risk for severe illness from COVID-19 can be found in CDC’s guidance (www.cdc.gov). The list includes chronic lung disease or moderate to severe asthma, serious heart conditions, immunocompromised (cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications), severe obesity (body mass index [BMI] of 40 or higher), diabetes, chronic kidney disease undergoing dialysis and liver disease. Individuals should consult their healthcare provide to determine whether they have medical conditions that place them at increased risk for severe illness from COVID-19. Individuals and families should consult their healthcare providers to determine whether they have medical conditions that place them at risk. _________________ o Staff and children living in households with individuals who are 65 years and older OR have higher risk for severe illness from COVID-19 are recommended to stay home.
Parent Signature
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By typing your name you are authorizing your signature.
ACKNOWLEDGEMENT, WAIVER AND RELEASE
COVID-19 Precautions
Read & Sign Precautions for the COVID 19 virus caused The Church of the Blessed Sacrament, 275 Union Avenue, Bridgeport, CT to implement new procedures and policies will be required. __________________________ The virus will be a factor in everyone’s life for some time to come, and there is no assurance that our precautions will prevent the virus from spreading. We are taking steps to reduce that risk, and we will adapt our procedures as circumstances may change, consistent with operating the Summer Camp for the education and enjoyment for your children. __________________________ 1. If they wish, parents may leave their children at the building entrance, remain outdoors, and pick them up from the building exit. Parents are required to wear masks and practice social distancing everywhere on the premises. 2. In addition, we will only allow one parent, with a mask, per family, to enter the building. 3. No one whose temperature that exceeds 100 degrees will be allowed to enter the building. We will be using a non-contact thermometer. Any person above that reading will not be allowed to stay on the premises and will have to leave immediately. 4. A hand washing video, as well as, a COVID 19 Virus Safety video will be shown each morning before breakfast. 5. There will be COVID 19 Virus Safety signage posted throughout the facility. __________________________ To permit and acknowledge The Church of the Blessed Sacrament, to conduct its summer camp in this fashion and release it from all liability relating to COVID 19, whether relating to you, your children, or other family members, please sign below.
Parent Signature
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By typing your name you are authorizing your signature.
Personal Information
Child's Name
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Child's Age
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Parent 1/Guardian 1 Name
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Parent 2/Guardian 2 Name
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Address
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E-mail
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Mobile Phone --
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Home Phone --
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Work Phone -- ext
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Secondary Contact Information
If I am unable to be reached, please contact:
Secondary Contact Name
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Address
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Relation to child
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Home Phone --
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Mobile Phone --
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Work Phone -- ext
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Allergies
**My child has the following allergies:
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Camp Fees and Trip Info
**All camp fees must be paid up to date by Monday for your child attend summer camp for that week** **Field Trips are tentative depending on Covid 19 Phase Reopening **
Camp Fee **The Camp Fee is $90 per week (includes t-shirt, trips, transportation, breakfast, lunch, and snack)
Week options **Field Trips are tentative depending on Covid 19 Phase Reopening **
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Field Trips
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By typing your name your are authorizing your signature.
Transportation Permission Form
Transportation Permission Form
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* to participate in the transportation program and to travel on a school bus for field trips with the Blessed Sacrament Church Camp. I also give my permission for daily transportation to and from camp as indicated on my child’s enrollment form as well as for emergency situations when the camp needs to be evacuated for the safety of the children.
Parent Signature
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By typing your name you are authorizing your signature.
Photo Release
Photo Release Permission Form As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the year for publicity, promotional, informational and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Please select one of the following choices
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Parent Signature
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By typing your name you are authorizing your signature.
Emergency Information
* In the event of an emergency and I cannot be reached please call:
Emergency Contact Name
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Emergency Contact Phone --
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Hospital Name
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Physician Name
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Physician Phone -- ext
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Dismissal Information
Please Indicate how your child will return home each day upon dismissal of the Blessed Sacrament Summer Camp.
Dismissal Options
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Behavior Contract Agreement
I will be honest about my actions and feelings. When I am frustrated or believe that I am being mistreated, I will talk with my counselors and I will not act out in an inappropriate way.
I will act in a caring and respectful manner to others. I will not talk back, use obscene or threatening language, or speak in an unkind manner about others. I will follow directions and listen attentively while participating in activities.
I will take responsibility for my own behavior, not blaming others for the choices I make. If I destroy something as a result of my inappropriate behavior or actions I will replace it.
I understand that my participation in the Summer Camp program may be limited or discontinued if I do not follow this contract.
Child Signature
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By typing your name you are authorizing your signature.
Parent Signature
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By typing your name you are authorizing your signature.
Date //
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FEE PAYMENT AGREEMENT
REGISTRATION FEE
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By typing your name your are authorizing your signature.
CAMP PAYMENTS
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By typing your name your are authorizing your signature.
PENALTY FEES
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By typing your name your are authorizing your signature.
STOPPED/RETURNED PAYMENTS
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By typing your name your are authorizing your signature.
CANCELLATION OF CAMP WEEKS
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By typing your name your are authorizing your signature.
Registration Checklist
REGISTRATION COMPLETION CHECKLIST
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Please email info to: DRE@BlessedSaccramentbpt.org or mail info to: 275 Union Avenue Bridgeport, CT 06607
Signature Authorization
In signing this form, I declare that all of the information is correct and attest that all necessary conditions concerning my child have been noted. I assume full responsibility for my child’s attendance in the Blessed Sacrament Church Summer Camp and give my permission for participation in all activities and trips. I have read and understand the above-mentioned Fee Payment Agreement and agree to abide by it.
Signature
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SIGNATURE FULL AGREEMENT I understand my Summer Camp Registration Fee of $90.00 is due with the submission of this (1) Summer Camp Registration Form, (2) Child's Medical Card (3) Completed Medication Administration record & authorization form (optional). REGISTER BEFORE JUNE 1 FOR A DISCOUNTED REGISTRATION FEE OF $80.00 for the first week.
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