2022 Global Citizens Summer Camp
For detailed information, please go to https://hopeccs.org/summerprograms/

SCHEDULE

* Weekly enrollment from 07/05/22 to 07/29/22
* Camp hours from 9:00 a.m. to 3:15 p.m.
* Free early drop off from 8:30 a.m.
* Pick up from 3:15 to 3:30 p.m.
* Optional extended hours from 3:30 - 5:30 p.m. with additional fees

COST

* Camp: $310/week (week 1: $250)
* Early Drop Off from 8:30 - 9:00 a.m.: FREE
* Extended Hours 3:30 - 5:30 p.m.: $70/week (week 1: $60)  
** Registration required

GROUPS (per 2021-22 grade level)

* Grades PK(5yo) - K
* Grades 1st - 2nd  
* Grades 3rd - 4th  
* Grades 5th & Up

DISCOUNTS & PAYMENT

* Full payment is due at the time of registration via ACH, cash, or check
* Sibling Discount: $20 off for each additional child enrolled
* Pay before 03/31/22 and get a 10% discount towards camp cost
* Discounts do not apply to After Care and cannot be combined with other discounts
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Email *
Student Information
(one form per student)
Last Name *
First Name *
Grade (in 2021-22 school year) *
Full Address *
Describe student's experience with Mandarin *
Parent/Guardian Information
Parent/Guardian #1 Full Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #2 Full Name *
Parent/Guardian #2 Phone Number *
Main email address for contact *
Emergency Contact
Please list an Emergency Contact other than parents/guardian
Full Name *
Relation to Student *
Phone Number *
(A) Camp Registration
Due to small group size or in the event of low enrollment, you may be ask to change session.
Sign up for *
Required
(A) Total Camp Cost *
(if applicable, $20 off sibling discount for each additional child enrolled or 10% off camp cost for early payment by 3/31/22) *discounts cannot be combined
(B) Optional Extended Hours
3:30-5:30 p.m. M-F
Sign up for: *
Required
(B) Extended Hours Fee *
Total payment (A)+(B) due upon registration                                                                                                                                                                                                             *
Payment Method *
Authorized Pick Up Other Than Parents:
Please note that you may be asked to show a valid ID when picking up students
Authorized Person Name:
Authorized Person Phone Number:
Relationship to Student
Medical Information
Allergies *
If yes, list all medical allergies below:
Food allergies *
List all food allergies below:
Medical conditions? *
If yes, please list:
Current medications:
(include prescriptions medications i.e. epi-pens, inhalers, etc, and non-prescription drugs: i.e.aspirin) If medication(s) need to be given during the day or an emergency kit needs to be kept at school, please contact the school for a Medical Administration Form
Doctor's Name *
Doctor's Phone: *
Doctor's office address *
Health Plan: *
ID# & Group Name: *
Health plan/insurance phone number: *
Hospital Preference *
If required, you agree to have your child taken to Providence St. Vincent Hospital
Authorization and Consent of Parent(s) or Legal Guardian(s) *
I do hereby solemnly swear that I have legal custody of the aforementioned minor child. I grant my authorization and consent for "Hope Chinese Charter School representative" (hereafter "Supervising Adult") to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Supervising Adult to summon any and all professional emergency personnel to attend, transport, and treat the participant and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Supervising Adult in the exercise of this or her best judgement upon the advice of any such medical or emergency personnel. This Authorization and Consent is effective from the date designated below and shall remain in full force and effect for such period of time my/our child is enrolled and/or participating in the summer programs at Hope Chinese Charter School.
Yes
I agree with the authorization and consent mentioned above.
I understand any changes in medical conditions or medications, is the responsibility of the parent/guardian to notify Hope Chinese Charter School.
Other Terms & Conditions
I agree to the following terms as indicated by checking the box next to each statement and signing my name below:

*
Required
*
Required
*
Required
*
Required
COVID-19 Parent/Guardian Acknowledgement: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Hope Chinese Charter School(HCCS)/Global Citizens Summer Camp (GCSC) has put in place protective measures to reduce the spread ofCOVID-19; however, HCCS/GCSC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending activities on the campuses of HCCS/GCSC could increase your risk and your child(ren)’s risk of contracting COVID-19. *
Required
Please read: *
Required
Signature of Parent/Guardian *
How did you hear about this camp?
A copy of your responses will be emailed to the address you provided.
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