Names and Addresses of Two People to Contact if Parents Cannot Be Reached relationship to camper: Phone 1. Complete Physical Address: 2. Complete Physical Address: relationship to camper: Phone In addition to above contacts. Other Person(s) AUTHORIZED To Pick Up Child Person(s) NOT Authorized To Pick Up Child* ***Appropriate paperwork such as custody papers shall be attached if a parent is not allowed to pick up the child. *** Please note: Documentation of required Immunizations must be provided as well as a copy of your child’s birth certificate. *If there is an objection to seeking emergency medical care, a statement should be obtained from the parent or guardian that states their objection and the reason for their objection. OFFICE USE ONLY - IDENTITY VERIFICATION PLACE OF BIRTH BIRTH DATE BIRTH CERTIFICATE # DATE ISSUED OTHER FORM OF PROOF WITNESS SIGNATURE Proof of the child’s identity and age may include a certified copy of the child’s birth certificate, birth registration card, notification of birth (hospital, physician or midwife record), passport, copy of the placement agreement or other proof of the child’s identity from a child placing agency, record for a public school in Virginia, or certification by a principal or his/her designee of a public school in the U.S. that a certified copy of the child’s birth record was previously presented. Viewing the child’s proof of identity is not necessary when the child attends a public school in Virginia and the center assumes responsibility for the child directly from the school (ie., after school program) or the center transfers responsibility of the child directly to the school (ie., before school program). While programs are not required to keep the proof of the child’s identity, documentation of viewing this information must be maintained for each child. ALL MEDICATIONS FROM HOME WILL NEED TO HAVE APPROPRIATE PAPERWORK FROM THE OFFICE FOR OUR STAFF TO GIVE AT CAMP. My child takes ________________________________________________________________________medication at home for_______________________.
Names and Addresses of Two People to Contact if Parents Cannot Be Reached relationship to camper: 1. Complete Physical Address: Phone 2. Complete Physical Address: relationship to camper: Phone In addition to above contacts. Other Person(s) AUTHORIZED To Pick Up Child Person(s) NOT Authorized To Pick Up Child* ***Appropriate paperwork such as custody papers shall be attached if a parent is not allowed to pick up the child. *** Please note: Documentation of required Immunizations must be provided as well as a copy of your child’s birth certificate. *If there is an objection to seeking emergency medical care, a statement should be obtained from the parent or guardian that states their objection and the reason for their objection. OFFICE USE ONLY - IDENTITY VERIFICATION PLACE OF BIRTH BIRTH DATE BIRTH CERTIFICATE # DATE ISSUED OTHER FORM OF PROOF WITNESS SIGNATURE Proof of the child’s identity and age may include a certified copy of the child’s birth certificate, birth registration card, notification of birth (hospital, physician or midwife record), passport, copy of the placement agreement or other proof of the child’s identity from a child placing agency, record for a public school in Virginia, or certification by a principal or his/her designee of a public school in the U.S. that a certified copy of the child’s birth record was previously presented. Viewing the child’s proof of identity is not necessary when the child attends a public school in Virginia and the center assumes responsibility for the child directly from the school (ie., after school program) or the center transfers responsibility of the child directly to the school (ie., before school program). While programs are not required to keep the proof of the child’s identity, documentation of viewing this information must be maintained for each child. ALL MEDICATIONS FROM HOME WILL NEED TO HAVE APPROPRIATE PAPERWORK FROM THE OFFICE FOR OUR STAFF TO GIVE AT CAMP. My child takes ________________________________________________________________________medication at home for_______________________.
Summer-Enrollment-and-registration-form-2018-web-1.docx