Summer 2021 Camp Registration

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**Camp fees are due 2 weeks prior to the start date of camp and are non-refundable.
All camps are open to children ages 1 1/2 through 11.

Email *

Child's Full Name (please fill out a separate form for each child) *

Child's Date of Birth *

YYYY

Select the session(s) your child will attend

Welcome Summer June 21-25, 9am-2pm

Proud to be an American July 6-9, 9am-3pm

STEAM (Science, Technology, Engineering, Art & Math) July 19-23, 9am-2pm

Child's Home Address *

Both Parent's/Guardian's Names *

Parent's Address (if different from child's)

Home Phone Number

Mother's Cell *

Mother's Work Phone Number

Father's Cell *

Father's Work Phone Number

Name & Ages of all other people living in the child's house: *

Name of Emergency Contact OTHER THAN PARENTS *

Phone Number of Emergency Contact *

Relationship of emergency contact to child *

Address of the Emergency Contact *

I hereby authorize SHEEP to allow my child to leave school only with the following persons. (children will only be released to a person designated by the parent/guardian after verification of ID) *Please include their phone number

My child may be transported and supervised by St. Helena's Episcopal School on field trips and for emergency care. *

I understand

Required

My child may attend all summer camp sponsored field trips. *

Yes

My child may participate in water play. *

Yes

I understand that my child will need to bring a lunch and snack each day. *

Yes

I give permission for St. Helena's Episcopal School to use my child's photograph, without their name, for camp use, on website, social media, in e-mails, in newspapers, brochures or other publications. *

I DO give my permission

I DO NOT give my permission

In the event that I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to this PHYSICIAN (name, address & phone number). *

In the event that I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to this MEDICAL FACILITY (name, address & phone number). *

By typing my name below, I give consent for St. Helena's Episcopal School to secure any and all necessary emergency medical care for my child. *

List any special problems that your child may have, such as, allergies, existing illnesses, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of. If none, please put N/A. *

Permission to Access Files: On occasion, other entities may ask for information about your child. In the event that information is being requested, St. Helena's staff will let you know. I understand that my child's personal information, medical records, and developmental assessments are confidential, and available to me upon request. I understand that the staff will have ongoing access to my child's file, records and assessment information. I grant St. Helena's, it's teaching staff and administrators, as well as regulatory agencies such as Texas Department of Health & Human Services permission to access my child's file, records and assessments as part of any required inspection. *

I give my consent to permission to access files.

I have viewed a copy of the St. Helena's Episcopal School Parent Handbook on the school web page. I have been given the opportunity to read the manual, ask questions, and I understand the policies contained therein. Furthermore, I agree to abide by the policies set forth in the manual. I understand that the policies described in the Parent Handbook are not conditions of enrollment, and the language does not create a contract between St. Helena's School and the parents. St. Helena's Episcopal School reserves the right to alter, amend, or otherwise modify these guidelines, in it's sole discretion, without prior notice. You will be notified of policy changes in writing. By typing BOTH parent's names, we acknowledge the above statement. *

Child daycare operations are public accommodations under the American with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA Information Line at 800-514-0301. Type your name below to show understanding. *

Today's Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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