2022 Kids Project Summer Camp Registration Form
Thank you for signing your child up for Kids Project Summer Camp.  This is going to be one fun summer with all the places our imaginations will take us.

We understand that the Covid-19 has created changes in many families financial situations, we will work with you to make sure that you can afford camp. We are not asking for a deposits or payments until May 1st.  

To register, simply fill out this form and pay the $100 non refundable security deposit by May 1, 2022  

June 20-August 12th $1600
June 20-August 12th sibling $1,500
June 27- August 12th-$1400
June 27- August 12th- $1,300
June 20-July 1- $600
July 5-July 15- $600
July 18- July 29- $600
August- 1- August 12-$600

We only are accepting 40 kids a day- if you need a flexible schedule, we recommend signing up for the whole summer, no need to attend everyday.

Staff ratio: 8 to 1  

Here's to a fun summer!
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Payment Information- we will bill you once we receive how you want to pay
I would like information about sliding scale tuition and scholarships.
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Registration & Payment
Before and After Care Options
After Care begins at 3:15pm until 6:00pm
Before Care
I would like to pay:
Payment Options
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Contact Information
1. Child's Name
2. Child's Name
3. Child's Name
1.Age
2.Age
3.Age
1.Gender
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2.Gender
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3.Gender
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1.Birthdate
2.Birthdate
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3.Birthdate
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Street Address
City
State
Zip
Main Cell Phone Contact
Name: Parent/Guardian#1:
Parent/Guardian#1: phone:
Parent/Guardian#2:
Parent/Guardian#2: phone:
Child Lives with
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ADULTS AUTHORIZED TO PICK-UP MY CHILD/EMERGENCY CONTACTS OTHER THAN PARENT/GUARDIAN (minimum of 2 are required)
1. Name
Relationship to child
Phone
2. Name
2. Relationship to child
2. Phone Number
UNAUTHORIZED PICK-UP: People who CANNOT pick up your child from CDE program:
AUTHORIZED PICK-UP/EMERGENCY PICK-UP: I,  agree 
to pick up my child and be contacted in the event of an emergency from the camp. In doing so, I relieve the Chicago Danztheatre Ensemble, its employees and agents from all responsibility for my child after he/she has been released from the program. Attempts will be made to reach the parent/legal guardian.
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Medical Information
Doctor's Name and Phone Number
The following questions are asked so that we may best serve your child in programs. Any information that you choose to disclose is confidential.
Are there any health conditions that you would like us to be aware of?
Will your child need to take medication? No or Yes (explanation):
Are there allergies that we should be aware of? No or Yes (explanation): Allergic reaction (describe)
Does your child require a medication, due to disability, in order to participate?
No or Yes (explanation):
Are there activities that your child should be exempt from due to health reasons?
Are all immunizations up to date?

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MEDICAL RELEASE: I do hereby give permission for the Chicago Danztheatre Ensemble staff to transfer child named above off property for the purpose of medical care as deemed appropriate by the Director and in the event that I cannot be reached in an EMERGENCY, I hereby give my permission to the physician selected by the Director, to hospitalize, to secure proper treatment for and to treat as appropriate  my child named above.
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Please describe your child’s interactions with children of the same age. How would you describe your child’s personality?
Does your child have any fears that we should be aware of?
Is there anything that we need to know about your child so that they many have a happy and productive camp experience?
AUTHORIZATION FOR SUNSCREEN: By signing this form, I acknowledge that I will sufficiently apply sunscreen to all of my child’s exposed skin, and agree that Chicago Danztheatre Ensemble Staff may reapply the spray sunscreen that I provide, labeled with my child’s name.
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PARTICIPANT INFORMATION PACKET
-Character Contract
-Talent Release
-Walking Field Trips
-Financial Agreement
-Facility User Aggreement  
CDE CHARACTER CONTRACT

If this contract is broken or if there is a conflict/interaction that involves strong feelings or serious negative behaviors the following steps will be taken.

Step 1: CDE staff will talk with campers in order to acknowledge feelings, gather information and create a plan to repair any harm that has been caused.

Step 2: If negative behavior persists or the plan to repair harm is not followed, parents will be asked to come to the program to discuss the issues and work toward a solution together with their child and CDE staff.

Step 3: CDE staff will monitor behavior closely and provide regular feedback to the camper and their parents.

Step 4: If the problem persists or camper does not follow the plan created and agreed upon, the parent may be contacted immediately to pick up their child from camp. The following morning, parents, staff and child will meet to discuss any additional supports that the child might need to be successful in the program.

Step 5: If the prior interventions are not successful AND youth behavior is impacting the physical or emotional safety of themselves, CDE staff or other campers, the child may be dismissed from the program for the remainder of session.
We agree to CDE's Character Contract
At Chicago Danztheatre Ensemble, we strive to create an equitable and empowering space for our artists, administrators, teachers, and audiences. We aim to build a platform for the voices of the diverse communities we serve. All are welcome.
TALENT RELEASE FORM-I give permission for my child, to be photographed, videotaped or interviewed during Chicago Danztheatre Ensemble’s residency programs. My child’s image may appear in print or online promoting the CDE’s activities and programs. I understand that my child’s name will not be used to identify my child. This permission form will be kept on file in the CDE’s office. If I would like to withdraw my permission, I may do so at anytime.
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I hereby given permission to participate in spontaneous, walking field trips throughout the summer. I understand that each trip will take place in the area, weather permitting, and the teachers will always accompany the children. Most of the time we are walking to the parks, a couple blocks away.
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FINANCIAL AGREEMENT: I understand that there is a $25 service charge assessed by CDE on all returned checks and declined monthly credit card/checking account drafts. I understand that I will receive written notice in advance of any change in the date of the payment plan or for any change in the amount due, and I authorize CDE to use such changed date or amount after the written notice is sent to me, unless I cancel this authority and the Payment Plan as provided above. I understand that it is my responsibility to update my contact information when there is a change of name, address, or financial institution or account.
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FACILITY USER/FIELD TRIP AGREEMENT:
I agree to follow all rules and regulations of the Chicago Danztheatre Ensemble and Wicker Park Lutheran Church while in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program and understand and agree that I may be expelled at any time, with no refund of any monies paid, for failure to abide by such rules and regulations.

IN CONSIDERATION OF BEING PERMITTED TO UTILIZE THE FACILITIES, SERVICES AND PROGRAMS OF THE CDE FOR ANY PURPOSE, INCLUDING BUT NO LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE CDE WITHOUT RESPECT AS TO LOCATION, I HEREBY AGREE TO THE FOLLOWING:

I UNDERSTAND THAT ACTIVITIES AT THE FACILITY OR ELSEWHERE, INCLUDING USE OF EQUIPMENT AND PARTICIPATION IN PROGRAMS, CAN INVOLVE MOVEMENT AND STRAIN.

I ALSO UNDERSTAND THAT PROGRAM ACTIVITIES INCLUDE FIELD TRIPS TO LOCATIONS OUTSIDE THE CDE’S PREMISES, AS DESCRIBED IN DETAIL IN THE PROGRAM MATERIALS, AND THAT PUBLIC OR PRIVATE TRANSPORTATION MAY BE UTILIZED TO TRANSPORT PARTICIPANTS TO AND FROM THESE FIELD TRIP LOCATIONS.

I, FOR MYSELF, ANY PERSONAL REPRESENTATIVES, ASSIGNS, HEIRS AND NEXT OF KIN, HEREBY FULLY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE CDE its operating centers, their respective directors, Board of Managers, Trustees, members, volunteers, employees or agents (the “Releasees”) and each of them from any and all claims for injuries, damage or loss that I or my minor child/ ward may incur whether in, upon or about the premises or while using or observing the premises or any facilities or equipment, or participating in any program affiliated with the CDE premises, except for any injury, damage or loss that is caused solely by the CDE’s gross negligence.

I further expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Illinois and if any portion thereof is held invalid, it is agreed that the remaining Agreement shall, notwithstanding, continue in full legal force and effect.

THIS AGREEMENT APPLIES TO ALL PAST, PRESENT AND FUTURE VISITS AND USES BY ME TO ANY CDE FACILITY OR PROPERTY.

I HAVE READ AND VOLUNTARILY SIGNED THIS FACILITY USE/FIELD TRIP AGREEMENT, and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE AGREEMENT. THIS AGREEMENT CONTAINS A WAIVER AND RELEASE.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
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.
 
Chicago Danztheatre Ensemble  (“the Studio”) has put in place preventative measures to reduce the spread of COVID-19; however, the Studio cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)’s risk of contracting COVID-19.
 
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Studio and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Studio employees, volunteers, and program participants and their families.
 
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Studio or participation in Studio programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Studio, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Studio, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Studio program.
 
I agree to notify the Studio if I (or child(ren) contact COVID so the Studio can take necessary precautions to ensure the safety of others. 
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
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By filling out your name below you are entering an agreement with CDE
A copy of your responses will be emailed to the address you provided.
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