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CAMPER #1

Name:_________________________________________________Grade entering in Fall 2018_____________

Male Female

camp/grade

Before Camp

Buddies/1 to 2

Voyagers/3 to 4 Adventurers/5 to 7 Summer Pals

Session 1

5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day

Session 2

5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day

1.

Is your child a swimmer?

Yes_____

No_____

2.

Does your child take any medication (over the counter or prescribed)? Yes_____

No_____

If yes, please specify: ______________________________________________________________________

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

3.

Does your child have allergies?

Yes_____

No_____

If yes, please list: __________________________________________________________________________

DAY CAMP EMERGENCY INFORMATION

Circle the camp & days you are selecting 5 days (M thru F) or 3 days (M/W/F)

1.

Is your child a swimmer?

Yes_____

No_____

2.

Does your child take any medication (over the counter or prescribed)? Yes_____

No_____

If yes, please specify: _____________________________________________________________________

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

3.

Does your child have allergies?

Yes_____

No_____

If yes, please list: __________________________________________________________________________

4.

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 #2

Name:_________________________________________________Grade entering in Fall 2018_____________

Male Female

camp / grade

Before Camp

Buddies / 1 to 2 Voyagers / 3 to 4 Adventurers / 5 to 7 Summer Pals

Session 1

5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day

Session 2

5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day 5 day 3 day

Camper’s Home Address:__________________________________________________________________________________________

Father/Guardian’s Name:_____________________________________ Mother’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 Aquatic Center and field trip destina-

tions 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: _______

4.

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