Camp Fire --Summer Programs 2013

1. Summer Camp Registration

50% of survey complete.

Camp WoHeLo Camp Information

Registration Fees for 2013 Season— Per Camper one-time fee.

Fees received by 15 April 2013 50.00
Fees received by 15 May 2013 75.00
Fees Received By 24 May 2013 125.00
Fees Received 25 May and after 150.00

Lions Basketball Camp- Children in Grades K-8 -Weeks of June 17 and June 24 2013 Cost $225 per week
Hours 8 AM to 4 PM- Breakfast and Lunch Provided. After Camp Care Available from 4 to 5:30 for an additional fee.

Little Stars Program For our Pre K 3-K students: Cost is $285 per week. Fees includes all expenses, field trips, Meals, and activities. This program is from June 17 to Aug 2, 2013. There is no early payment option for this program.

Starflight and Adventure Program For youth in Grades 1-5: $560 per 2 week session. IF full fee for 6 weeks is paid by 1 June the fee is $1585 for the 6 week Program beginning June 24 and ending Aug 2.

Discovery Program For Middle School Youth: $560 per 2 week session. IF full fee for 6 weeks is paid by 1 June the fee is $1575 for the entire program

Summer School OPTION For Youth Attending St Francis Summer School Program and needing a Part time camp option—Cost $300.00 per 2 week Session. Campers will join the Camp Program at lunch time and will participate in the summer camp program. They will be assigned to a camp group which will remain the same for the entire summer program so that they have an opportunity to build friendships and feel a part of the summer camp program. Students will have an option of attending some field trips that are consistent with their Summer school program. Some special enrichment programs will be planned for these students when Camp Program is on a full day field trip.

Teen Programs
Students in Grades 9-12: Sumester of Service program which engages students in service learning and leadership activities and meets school service requirements in all school systems. Students will engage in service opportunities in the community as well as in the Camp Program including field trips and a three day 2 night CF66 service-learning road trip. Fee for this program is $435. The fee includes all travel expenses, program fees, admissions and meals during the travel portion of the program. Students are responsible for all incidental costs. This program is offered over a 10 week period beginning 7 June 2013.

Campers in Leadership in Training CILTs Program—Cost $ 450 per session. Camp Fires Counselor in training program is offered in 2 2 week sessions. June 24th through July 5th and July 22 to Aug 2. Students participating in this program participate in the Camp Fire and American Camp Association Counselor in training program and upon completion of all levels of training are eligible for certification as Camp Counselors. The program prepares youth to serve as counselors in a variety of settings. Included in this program is a 2 night overnight camping program that prepares these youth for supervising youth in overnight camp programs and outdoor education.

CF66 Service Learning Road Trip—Cost $625. This Sunday through Saturday Service learning trip engages students in service emersion in a variety of settings and with a variety of populations. Students Travel to a variety of locations within the Mid-Atlantic area and provide service around a theme. Student leadership is a key component of this program. Students live with other students, explore issues of poverty, advocacy, and social justice and explore their own attitudes and feelings as they relate to these issues. Challenges designed by other students provide opportunities for critical thinking and analysis of problems. One Trip will be the last week of July and the other the 2nd week of August.

Upon receipt of the online registration we will send you an invoice through our PayPal payment system. This will detail all costs due.

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* 1. Please indicate who is completing this form

Parent/Guardian

school advisor

Other (please specify)

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* 2. Did you attend Camp Last year

Attended Basketball CAmp

Attended Traditional Camp

Attended Geek Squad

Attended Teen Camp

Did not attend last year

Other (please specify)

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* 3. Are you a member of Camp Fire

Yes

comment

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* 4. How many campers are you registering for this camp?

one

two

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* 5. Which Session do you wish to attend--Mark All that apply.

	Child 1	Child 2	Child 3
Basketball Camp June 17	Basketball Camp June 17 Child 1	Basketball Camp June 17 Child 2	Basketball Camp June 17 Child 3
Basketball Camp June 24	Basketball Camp June 24 Child 1	Basketball Camp June 24 Child 2	Basketball Camp June 24 Child 3
Before Care 7-9 AM	Before Care 7-9 AM Child 1	Before Care 7-9 AM Child 2	Before Care 7-9 AM Child 3
After Care 4-5:30 PM	After Care 4-5:30 PM Child 1	After Care 4-5:30 PM Child 2	After Care 4-5:30 PM Child 3
Pre School Camp Ages 3-5 -	Pre School Camp Ages 3-5 - Child 1	Pre School Camp Ages 3-5 - Child 2	Pre School Camp Ages 3-5 - Child 3
Pre School Camp -Weekly Option (indicate weeks in comment box)	Pre School Camp -Weekly Option (indicate weeks in comment box) Child 1	Pre School Camp -Weekly Option (indicate weeks in comment box) Child 2	Pre School Camp -Weekly Option (indicate weeks in comment box) Child 3
Grades 1-8 Full 6 week Program	Grades 1-8 Full 6 week Program Child 1	Grades 1-8 Full 6 week Program Child 2	Grades 1-8 Full 6 week Program Child 3
Grades 1-8 Session One June 24-July 5	Grades 1-8 Session One June 24-July 5 Child 1	Grades 1-8 Session One June 24-July 5 Child 2	Grades 1-8 Session One June 24-July 5 Child 3
Grades 1-8 Session 2 july 8-19	Grades 1-8 Session 2 july 8-19 Child 1	Grades 1-8 Session 2 july 8-19 Child 2	Grades 1-8 Session 2 july 8-19 Child 3
Grades 1-8 Session 3 July 22-Aug 2	Grades 1-8 Session 3 July 22-Aug 2 Child 1	Grades 1-8 Session 3 July 22-Aug 2 Child 2	Grades 1-8 Session 3 July 22-Aug 2 Child 3
1-8 Summer school option12-4 each day July 24-Aug 2	1-8 Summer school option12-4 each day July 24-Aug 2 Child 1	1-8 Summer school option12-4 each day July 24-Aug 2 Child 2	1-8 Summer school option12-4 each day July 24-Aug 2 Child 3
Sumester of Service Program	Sumester of Service Program Child 1	Sumester of Service Program Child 2	Sumester of Service Program Child 3
CIT/CILT Program	CIT/CILT Program Child 1	CIT/CILT Program Child 2	CIT/CILT Program Child 3
CF 66 (requires special application which will be sent upon receipt registration)	CF 66 (requires special application which will be sent upon receipt registration) Child 1	CF 66 (requires special application which will be sent upon receipt registration) Child 2	CF 66 (requires special application which will be sent upon receipt registration) Child 3
Service Learning Emersion Program (Teens)	Service Learning Emersion Program (Teens) Child 1	Service Learning Emersion Program (Teens) Child 2	Service Learning Emersion Program (Teens) Child 3
Volunteer In Practice(Very Limited Space)	Volunteer In Practice(Very Limited Space) Child 1	Volunteer In Practice(Very Limited Space) Child 2	Volunteer In Practice(Very Limited Space) Child 3

For Pre-school options other than full 7 weeks, please provide dates you wish your child to attend.

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* 6. Please provide the following Registration Information for participation Camp Program. It is our practice to communicate with both the students and the parents for risk management reasons. Youth receiving emails at their own address must also have listed a parents email address for this reason. If your child does not have email please put NONE in the box.

Child one--

Last Name

First Name

Date of Birth

Age

Grade in Fall 2013

School

Home street address

City

State

Zip

HOme phone

Student Cell phone

Student Email Address

Do you speak Spanish Fluently

Do you speak French Fluently

Parent 1 Parent/Guardian's First Name

Parent 1 Parent/Guardian's Last Name

Parent 1 Parent/Guardian's Email address

Parent 1 Parent/Guardian's Preferred contact number

Parent 1 Occupation

Parent 2 Parent/Guardian's First Name

Parent 2 Parent/Guardian's Last Name

Parent 2 Parent/Guardian's Email address

Parent 2 Parent/Guardian's preferred Contact number

Parent 2 Occupation

Emergency Contact if Parents are not available Name

Emergency Contact Relationship

Emergency Contact Phone number

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* 7. Child 1 Do you have any medical conditions or allergies that we should know about to keep you safe during Camp Fire Activities? Please provide an explanation in the box below.

	Yes	NO
Allergies to Medications	Allergies to Medications Yes	Allergies to Medications NO
allergies to Food	allergies to Food Yes	allergies to Food NO
Medical Conditions	Medical Conditions Yes	Medical Conditions NO
Are your immunizations up to date?	Are your immunizations up to date? Yes	Are your immunizations up to date? NO
Was your last tetanus shot in the last 12 months. Please list date in box below?	Was your last tetanus shot in the last 12 months. Please list date in box below? Yes	Was your last tetanus shot in the last 12 months. Please list date in box below? NO
Are you taking any medications	Are you taking any medications Yes	Are you taking any medications NO
Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants)	Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants) Yes	Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants) NO

Explain any Yes Answers in this space

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* 8. Child two if Applicable

Last Name

First Name

Date of Birth

Age

Grade in Fall 2012

School

Home street address if different from Child 1

City

State

Zip

HOme phone

Student Cell phone

Student Email Address

Do you speak Spanish Fluently

Do you speak French Fluently

Emergency Contact if Parents are not available Name

Emergency Contact Relationship

Emergency Contact Phone number

Question Title

* 9. Child 2 Do you have any medical conditions or allergies that we should know about to keep you safe during Camp Fire Activities? Please provide an explanation in the box below.

	Yes	NO
Allergies to Medications	Allergies to Medications Yes	Allergies to Medications NO
allergies to Food	allergies to Food Yes	allergies to Food NO
Medical Conditions	Medical Conditions Yes	Medical Conditions NO
Are your immunizations up to date?	Are your immunizations up to date? Yes	Are your immunizations up to date? NO
Was your last tetanus shot in the last 12 months. Please list date in box below?	Was your last tetanus shot in the last 12 months. Please list date in box below? Yes	Was your last tetanus shot in the last 12 months. Please list date in box below? NO
Are you taking any medications	Are you taking any medications Yes	Are you taking any medications NO
Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants)	Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants) Yes	Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants) NO

Explain any Yes Answers in this space

Question Title

* 10. Child Three if Applicable

Last Name

First Name

Date of Birth

Age

Grade in Fall 2012

School

Home street address if different from Child 1

City

State

Zip

HOme phone

Student Cell phone

Student Email Address

Do you speak Spanish Fluently

Do you speak French Fluently

Emergency Contact if Parents are not available Name

Emergency Contact Relationship

Emergency Contact Phone number

Question Title

* 11. Child 3 Do you have any medical conditions or allergies that we should know about to keep you safe during Camp Fire Activities? Please provide an explanation in the box below.

	Yes	NO
Allergies to Medications	Allergies to Medications Yes	Allergies to Medications NO
allergies to Food	allergies to Food Yes	allergies to Food NO
Medical Conditions	Medical Conditions Yes	Medical Conditions NO
Are your immunizations up to date?	Are your immunizations up to date? Yes	Are your immunizations up to date? NO
Was your last tetanus shot in the last 12 months. Please list date in box below?	Was your last tetanus shot in the last 12 months. Please list date in box below? Yes	Was your last tetanus shot in the last 12 months. Please list date in box below? NO
Are you taking any medications	Are you taking any medications Yes	Are you taking any medications NO
Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants)	Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants) Yes	Have you scheduled an appointment with your physician for a pre-camp physical? (required for all sports camp participants) NO

Explain any Yes Answers in this space

Question Title

* 12. I am interested in finding out bout other CAmp Fire USA Summer And School Year Programs. We will email you information about the programs you select.

	Please send info
Other Summer programs	Other Summer programs Please send info
Teen Service Learning Road Trips (Meet school service Hour Requirements)	Teen Service Learning Road Trips (Meet school service Hour Requirements) Please send info
School year programs for youth K-8	School year programs for youth K-8 Please send info
High School Teens in Action Programs year round.	High School Teens in Action Programs year round. Please send info
I am interested in Adult leadership and volunteer opportunities.	I am interested in Adult leadership and volunteer opportunities. Please send info

Email where you would like info sent.

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* 13. Parents may enter any questions they have relating to this program. WE will respond as quickly as possible.

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* 14. Statement of Agreement:

I understand that by completing this form I am registering my child(ren) for the Camp Fire summer camp program. I will receive an invoice for summer camp summarizing my charges based on the elections I have made on this form. I understand that I must have all payments for by the payment plan I choose. There will be a $ 35 fee for all returned checks. If I choose to pay using the online payment system, I understand that there will be a convenience fee for this option. Please sign your name

By checking this box I understand and agree to the information in the Statement of Agreement.

By checking this box I request online invoicing for payment of Camp Fees and Registration.

By Checking this box I understand that I will have to complete a Health Form for My child

By checking this box I understand that I will have to complete an Full Application form for my child

By checking this box I understand that my child must have a physical examination that is dated after July 30 2012

For those in Basket Ball Camp--I understand I will need an additional medical release for my child to participate

By checking this box, I understand that if my child is in grades 6 or higher, they will need to sign a code of conduct form.

By checking this box, I understand that all youth 10-18 will be provided an opportunity to participate in Camp Fire's Thrive Program.

Please Print your Name and date in this box as verification of your signature.\

Question Title

* 15. Skip this question--Archive

By checking this box I understand and agree to the information in the Statement of Agreement.

By checking this box I request online invoicing for payment of Camp Fees and Registation.

By Checking this box I understand that I will have to complete a Health Form for My child

By checking this box I understand that I will have to complete an Full Application form for my child

By checking this box I understand that my child must have a physical examination that is dated after July 30 2012

For those in Basket Ball Camp--I understand I will need an additional medical release for my child to participate

By checking this box, I understand that if my child is in grades 6 or higher, they will need to sign a code of conduct form.

By checking this box, I understand that all youth 10-18 will be provided an opportunity to participate in Camp Fire's Thrive Program.

Please Print your Name and date in this box as verification of your signature.\