Summer Camp Enrollment

Child's Full Name

Child's Date of Birth

Month

Day

Year

Guardian 1's Full Name

Email

Phone

Guardian 2's Full Name

Email

Phone

Authorized Pick-ups

Who, other than the above-listed guardians, is authorized to pick-up your child?

Name, Relationship to Camper, Phone Number

Emergency Contact and Emergency Treatment Consent

Who should be contacted in an emergency?

Name, Relationship to Camper, Phone Number

CONSENT FOR EMERGENCY TREATMENT: If the camp is unable to promptly locate a designated emergency contact, camp authorities may take any emergency measures they deem appropriate and shall notify the parent or legal guardian as soon as possible. I provide consent for emergency treatment of my child. Please provide their name below and your initials, which will serve as a digital signature.

Signature

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I provide consent for emergency treatment of my child.

About Your Child

An opportunity for you to share any info about allergies, medications, special needs and personality. If not applicable, please write N/A.

Please tell us about your child, including personality, energy level, and history of schooling or daycare. This aids us in forming groups at camp.

Does your child have any allergies or dietary restrictions? Please describe below, including severity of allergies.

Will you be sending any medications to camp for your child? If so, please elaborate.

Please apply bug spray and sunscreen on your child before camp drop off. It may be necessary to reapply later in the day.

I will provide and allow Our Backyard staff to apply the following on my child.

Sunscreen

Bug Spray

I do not give permission for Our Backyard staff to apply sunscreen and/or bug spray

You may send topical after-bite ointments for the child to self-apply with staff supervision, to prevent scratching itchy mosquito bites.

I will provide and allow Our Backyard staff to apply after-bite ointments on my child.

Yes

No

I do not give permission for Our Backyard staff to apply anti-itch ointments

Please describe any special needs your child has (behavioral goals, developmental needs, etc.). Please share specific ways that we can support them (and you). If your child has an IEP or 504 plan, upload it below or email it to ourbackyard.nyc@gmail.com.

Upload your child's IEP or 504 Plan

Attachments

I have read and completed the Participant Release Waiver.

I have read and completed the Child Health Form.

Upload your completed Participant Release Waiver

Upload your child's most recent Health Form.

The form must be current (filled out less than one year from the last day your child is attending camp). Upload any your child's most recent Health Forms or email them to ourbackyard.nyc@gmail.com.

Registration

Summer Camp Enrollment

Authorized Pick-ups

Emergency Contact and Emergency Treatment Consent

About Your Child

Attachments