Thoreau VIP Summer Camp 2022 Application & Registration Form
The VIP Summer Program will be held in-person at Thoreau Middle School this summer!  Rising 6th, 7th and 8th graders residing in Fairfax County within boundaries for the following middle schools are invited to register: Glasgow MS, Holmes MS and Poe MS. Rising 7th and 8th graders residing in Fairfax County within boundaries for the following middle schools are invited to register: Kilmer MS, Thoreau MS and Luther Jackson MS.

Program Details:
Mondays - Fridays, 9 am - 4 pm (site is available at 8 am for parent drop-offs)
June 29 - July 28 (camp will not meet on Monday July 4, Tuesday July 5 and Friday July 29)

Registration Policy: VIP camp costs $50 to attend (scholarships are available in cases of financial hardship - reach out to your school's After-School Specialist). Registrations will be accepted on a first come, first served basis. Each school has a designated number of spots allocated. The deadline for all applications is Friday, May 20th.  Call or email your local After-School Program Specialist (ASPS) or Fairfax County Teen Center (listed on the first page) for further information.  Students who submit the VIP Camp Registration Form will be notified if they have been accepted into camp.  Accepted participants will receive a confirmation letter/email along with further camp instructions.  Payment will be due after receiving confirmation of acceptance and no later than Friday, June 3rd.  Payments should be submitted through MySchoolBucks.  If you need to submit cash/check payment, please contact your After-School Specialist.  If payment is not received by Friday, June 3rd, participants will forfeit their place in the camp and will be replaced by another student, pending the payment of the camp fee.  Please contact the After-School Program Specialist at your student’s school if there are any payment concerns.

Refund Policy: To request a refund of the VIP Registration Fee, contact the After-School Specialist at the VIP Camp site prior to the cutoff date of Friday, June 10th.  Refund requests submitted after the cutoff date will not be considered.  Refunds will be in the form of a check.  Please allow 3-4 weeks for processing.  

Mandatory Parent Meeting: Parents/Guardians are required to attend a VIP Camp virtual orientation session for their child(ren) to participate in the VIP Summer Camp.  If you are unable to attend, please let your school’s ASPS know in advance.  During this virtual meeting, parents/guardians will have an opportunity to meet the staff and hear about the program.  Students will be moved to a waitlist if parents do not attend this meeting without giving prior notice. Please see the first page of this packet for your camp’s virtual meeting date.  


Section 1: Program Days and Hours of Operation:

Eligibility and Registration: Children who are residents of Fairfax County or Fairfax City, and are between 7th grade (entering fall of 2022) and 8th grade (entering fall of 2022), are invited to participate.  Glasgow, Holmes, and Poe families only: 6th graders (entering fall of 2022) are also eligible.  This program is designed for middle school age youth.  Individuals are encouraged to register early. Rising 9th graders (entering fall 2022) are encouraged to attend Neighborhood and Community Service’s (NCS) Teens in Action Summer Program.  Visit their website for more information.

Staffing for VIP Summer Camps: VIP camps are staffed by the FCPS After-School Program Specialists (ASPS) and staff, Fairfax County Department of Neighborhood and Community Services (NCS) staff, and other county agencies.

Meals: Unless otherwise noted, students will need to bring a bagged lunch each day to camp. VIP will provide a snack each afternoon. If we are able to provide meals, your VIP site staff would notify participants prior to the start of camp.

Inclusion: Fairfax County Government and Fairfax County Public Schools are committed to the success and inclusion of participants of all abilities. Reasonable accommodations and/or modifications will be made to afford eligible students with disabilities meaningful access to the array of group activities offered to program participants.  All participants are encouraged to submit applications by May 20th. Once an applicant has been accepted, the parent/guardian of a student with disabilities must contact the after-school program specialist at their middle school and provide complete information about the student’s disability at least three weeks prior to the beginning of camp so that a determination can then be made as to whether the student can be reasonably accommodated.  These are site-based informed decisions made after consultation with special education teachers, after-school program specialists, NCS center directors and Therapeutic Recreation Services. All determinations will be made on an individual basis, with the success of the participant in mind.

Camp Days and Hours: VIP Camps will run on Mondays – Fridays from 9:00 am – 4:00 pm from Wednesday, June 29 – Thursday, July 28.  As a service to parents, a limited number of staff will open sites at 8:00 am for early drop-offs.   Students will not be able to enter the site until 8:00 am, so please do not drop off your student before that time. There will be no camp held on July 4th and 5th.  

Transportation:  In the morning, school buses will pick up VIP campers from select schools and community locations and transport them to the VIP Camp site.  In the afternoon, school buses will transport students from the VIP Camp site to select schools and community locations.  Bus information will be available in June prior to the start of camp.

Field Trips:  We will take approximately 3-5 field trips throughout the summer.  There is a cost for students to attend the field trips.  Field trip fees will cover admission costs and bus transportation.  Field trip information (dates, locations, and fees) will be available by June 3rd.  The field trip fees need to be paid for in cash or through MySchoolBucks.  Fees will be collected in advance and will not be accepted the day of the trip.  To maintain safe staff to student ratios, we will send all staff members on the field trips and none will remain at the VIP site.  If your student chooses not to attend a field trip, please make alternate plans as sites will be closed that day.  Please speak with your After-School Specialist if financial assistance is required.

The VIP Summer Camp is jointly sponsored by the Fairfax County Department of Neighborhood and Community Services and Fairfax County Public Schools and is exempt from licensure by the Virginia Department of Education and has no direct oversight by the Virginia Department of Education. 


Section 2: Policies and Procedures

Students and parents sign on the signature page to show agreement after reading.

Medical Emergency: Camp employees have permission, in the event I cannot be reached readily in an emergency, at my expense to contact our family physician, and/or utilize the most convenient rescue squad vehicle or ambulance to transport my child to the nearest hospital.

Permission: I hereby grant permission for my child to participate in any or all of the programs, special events, walking and bus trips, including swimming, sponsored by the camp. I understand that participation by my child is completely voluntary, and that some of the planned physical activities may expose my child to some potential injury.  I agree that, to my knowledge, my child is physically and medically able to participate in these activities.  If any injuries do occur to my child, I also understand that school and County personnel will respond in the same manner that occurs during regular school hours. Field trip forms will be distributed.

Photo/Information Release: By signing this form, I give permission for my child to be photographed and/or videotaped for use in publicizing FCPS/NCS programs and services.  Youth registration information provided to the VIP Camp is public record and as such may be released under the Virginia Freedom of Information Act (VFOIA) unless the parent/guardian specifically requests that this information not be released.  Please check the box below if you do not grant the camp permission to release your child’s registration information.

Information: In accordance with the Virginia Privacy Protection Act of 1976, the requested information will be used to coordinate activities of this agency.  I understand that some of the information contained in this form may be released to persons who request such information in accordance with the requirements of the Virginia Freedom of Information Act (VFOIA), VA. Code §22-3705.  As this statement indicates, not all information the camp collects is subject to availability under the VFOIA.  

Behavioral Issues: If the actions of a participant may cause injury to themselves, other participants, or staff, camp staff reserves the right to deny his/her continuation in the program.  If property is stolen, destroyed, or damaged, payment may be required to pay for replacement or repairs.  Please do not bring any valuables (to include cell phones, iPods, cameras, or other electronic devices) to camp. Loss or damage to these items is not the responsibility of FCPS/NCS.

Participation: The VIP Camp is a structured enrichment, recreation, and academic program.  Parents may pick their children up at any portion of the day from the school office.  The coming and going of participants is the responsibility of the parents.  Should a child leave the camp for any reason, a parent will be contacted and the child is no longer the responsibility of the camp staff.  If a child misses more than three consecutive days of camp activities without prior arrangement with camp staff, that slot may be assigned to another student.

Transportation: Transportation to and from the camp will be provided by FCPS from selected stops within the neighborhood.  

Parental Responsibilities: Transportation to and from the bus pick-up/drop-off sites is the responsibility of the parent/guardian.  Parents/Guardians may transport their child(ren) to/from the camp.  Parents must have alternative transportation arrangements in case of emergency, illness, or disciplinary problems.  The middle school VIP Camp site does not open until 8:00 am for parent drop-offs.  The program starts at 9:00 am and ends at 4:00 pm.  VIP Camp does not provide ANY extended supervision after the 4:00 pm camp end-time.   Students may take a bus to the teen center at 4:00 pm and parents can pick-up from there.  A separate registration form for the teen center must be on file for a student to attend there.

Late Pick-Ups: The VIP program ends at 4:00 pm.  Continued late pick-ups may result in the loss of services.  
If you are running late, please notify the VIP site by 3:45 pm.  If you have not contacted the program and staff cannot reach you, an emergency person will be contacted to pick up your child.  If your emergency contact is unavailable to pick up your child, Child Protective Services may be called.


Section 3:  Rules of Conduct

Students and parents sign on the signature page to show agreement after reading.

Participants:
Follow the same guidelines provided by the FCPS Student Rights & Responsibilities document.
Stay in your assigned group.
You must inform staff before leaving the VIP Summer Camp.  Parents will be called when their student signs out to anyone other than a parent.
Show respect for others in what you do and say.
Attend regularly.
Be involved in your activities each day and encourage others to do so as well.
Listen to the VIP Summer Camp staff and follow directions carefully.
Maintain your self-control.  The VIP Summer Camp staff member will listen.
Take care of your personal belongings.  All electronic devices should be left at home (i.e. cell phones, iPods, air pods, etc.).  VIP staff is not responsible for the loss of any of these items.  All electronic devices that are brought to camp are the responsibility of the student and will only be allowed during designated times.  
Use equipment and supplies appropriately without destruction.
Have fun!

Parents:
Must attend the VIP Summer Camp Parent Orientation Session on the specified date on the first page of this packet.
Support the VIP Camp staff and work with them to resolve disciplinary problems.
Understand that the coming and going of your student is a parent’s responsibility.
Understand that the VIP Camp does not open until 8:00 am for parent drop-offs.  
Understand that the VIP Camp does not provide ANY extended supervision after the 4:00 pm camp end-time.  Students may take a bus to a teen center and parents can pick-up from there.  A separate teen center registration form must be completed for your student to attend there.
Make arrangements for the participant to be picked up in the event of sickness, inappropriate behavior, or other emergency needs.

Termination of Service/Ineligible for Services:
If the student’s actions cause injury to self, peers, and/or staff.
If the student exhibits inappropriate behavior which may inhibit participation in activities.
If the student engages in repetitive, aggressive, harmful, and/or disruptive behavior.
If the student fails to follow the general rules of conduct.
If the student is involved in theft of any kind.
If the student engages in any drug related activity (ATOD).
If the student is involved with the destruction of school property.
If the student does not meet the eligibility criteria for the program.

Behavior Guidance and Management:
From time to time the VIP Summer Camp staff must take actions to resolve a problem that is disruptive to the program and other participants.  Behavior¬ guidance requires very specialized skills.  We appreciate your support as staff try to find a solution that promotes non-disruptive behavior and allows your child to participate without incident in the activities.  Staff members use a proactive, restorative practices approach to meet the needs of the children by planning age and ability appropriate activities, selecting a variety of play and recreation activities, discussing the needs of the children with their parents, and evaluating the entire environment.  The safety of the participants and staff is of paramount concern.


Participants should plan on bringing the following to camp every day:

o Water Bottle (labeled with your child’s full name) – water fountains are only for re-filling at this time
o Hand sanitizer (optional)
o Lunch
o Tissues for personal use (optional)
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Email *
Student Email Address *
FCPS Student ID Number *Please enter your student's 7 digit FCPS student ID number. To ensure that FCPS students are properly enrolled, IT IS IMPORTANT THAT YOU ENTER A CORRECT STUDENT ID. (If your child does not attend a Fairfax County Public School, you may enter 9999999 in this required field.) *
Camper's FIRST Name *
Camper's LAST Name *
Camper's Date of Birth
MM
/
DD
/
YYYY
Grade *
Please check the boxes for the program dates your teen will be attending the VIP Camp. Participation in all weeks of camp is strongly encouraged in order to receive the greatest benefit from the planned enrichment, recreation, and academic activities *
Required
Student's 2022-2023 FCPS School
Gender *
If you need Morning & Afternoon Bus Transportation to Thoreau MS, please choose from the list of options.  We will be requesting several elementary feeder school stops based on need and location of campers.  Stops are subject to change as they still need to be approved by FCPS Transportation.  Route lists will be available in June prior to the start of camp. *
Buses will pick up between 7:45 and 8:30 am, depending on stops, and drop off by 9:00am at Thoreau MS.  Bus information will provided in June prior to the start of VIP.
Camper's Address - Please Complete Each Entry below as asked
YOU MUST PROVIDE A COMPLETE AND ACCURATE ADDRESS or risk being dropped due to an incomplete application.
 House #, Street Name, and Apt # if applicable *
City *
Zip Code* *
#1 Parent/Guardian to Contact *
Please list the parent or guardian to contact FIRST in case of an emergency or to discuss the camp.
#1 Parent/Guardian Name *
#1 Cell Phone *
Parent/Guardian cell phone number
#1 Work/Daytime Phone *
Parent  or Guardian's work or daytime number.
#1  Parent Email Address *
Email address for parent/guardian.  Please double check for accuracy.
#2 Parent/Guardian to Contact *
Please list the second adult to contact to discuss camp information or in case of an emergency.
#2 Emergency Contact Name *
#2 Cell Phone *
Emergency Contact's cell phone number.
#2 Work/Daytime Phone *
Emergency Contact's daytime phone number.
#2 Email Address
optional
Other Parent/Guardian's Name
If you wish, provide an additional parent or guardian's name and information here.
Other Parent/Guardian's Daytime Phone
optional
Other Parent/Guardian's Email Address
optional
Child Will Be Transported to VIP By:
Clear selection
Physician *
Physician name and phone number
Any allergies? *
Please check all that apply and enter any other allergies or food restrictions under "Other."
Required
Emergency Medications *
Please check any emergency medications your child must have available. You must supply prescribed medications and medical authorization forms for each Rx that may require administration at camp.
Required
Restrictions
Let us know if there is any condition that might limit your child's ability to participate in any aspect of camp.
While at camp, students will participate in clubs.  Please rank your TOP 4 preferred clubs  We will try to match students up with their preferences as much as possible, but all are subject to changed based on capacities, enrollment, and budget constraints.  
1 - most preferred
2
3
4
Art
Soccer/Futsal
Volleyball
Anime
Cooking Club
Basketball
Gaming
Robotics
Board games
Flag Football
STEM
Fitness
Has your student been offered a spot in the Imagine or Young Scholars summer programs?  We will be reserving some VIP spots for students in these programs.  We are working on logistics to get FCPS buses to transport students mid-day from Imagine/Young Scholars to VIP.  Spaces in VIP are limited so we will be in touch if your student is selected to participate in VIP after the Imagine/Young Scholars dismissal at 11:20 am. *
My Child Is On An IEP
Clear selection
How did you hear about the VIP Camp? *
This helps us evaluate the effectiveness of our advertisement efforts.
Required
Please check the box below if you do or do not grant the camp permission to release your child’s registration information. See section above "Photo Information Release" for more details.
SIGNATURE SECTION! Please initial that you have read each of the following sections: Section 1: Program Days and Hours of Operation, Section 2: Policies and Procedures, Section 3: Rules of Conduct & Section 4: Student Information
I certify that my child and I have read and understand all policies and procedures of the VIP Summer Camp packet which are associated with the operation of the VIP Summer Camp program and have been made aware of the VIP Summer Camp program rules including FCPS Student Rights and Responsibilities. (Parent/Guardian Electronic Signature in the space below).
Is there any other information you would like to share or like for us to know?
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