Spring Camp Registration

Join us for another fun camp. We have a lot to offer this spring break!

 Some highlights are:

-Hatching baby chicks (please let us know if you are interested in some)

-Getting to know Bandon with a presentation from Jim Proehl (from the Bandon Museum) and Mayor Mary Schamerhorn                                                                                                                                                                       

-The Beet Project will be coming to do lots of seed starting and getting our garden ready                                       

 -Daily STEM projects, Color Me Happy Art & Paint Parties (Samantha Peters) is coming to do a spring painting

-Coos Forest Patrol and Smokey Bear will be letting us see the big rigs and showing us how to use a fire hose   

-Core10 will offered and Tobias will be offering a 3 day, 1 hour sessions boot camp. (Please note Core10 is an additional $10 per day if you would like to sign your kid up).                                                                                           

-Daily walks to the playground, variety of crafts, scavenger hunt, a walk to get ice cream, make our own bird feeders, and baking muffins.

_____________________________________________________________________________________

 Monday-Wednesday | $30 Per day | 8:00am - 5:30pm | Late pick up fee $1 per minute | 5-12 yrs old

CORE 10 - $10 additional per day | Lunch not provided, please send one w/child | Daily snacks provided

An email will be sent confirming your registration was received within 2 days.

~If you are already a BCYC member, you can stop after question 8.~

Sign in to Google to save your progress. Learn more
1.) Is this your child's first time participating in BCYC programs? *
2.) Parent/Guardian Name *
3.) Parent/Guardian Phone Number *
4.) Parent/Guardian Email *
5.) Home Address *
6.) What days do you plan on attending camp? *
Required
7.) Do you wish to have your child participate in Core10 for an additional $10 per day? *
8.) Do you need a scholarship for Core10? *
Participant Name 1
Participant Date of Birth
Participant Name 2
Participant Date of Birth
Participant Name 3
Participant Date of Birth
Participant Name 4
Participant Date of Birth
Emergency Contact (Name, Relationship to Participant, Contact Number)
Emergency Contact (Name, Relationship to Participant, Contact Number)
Please list any medications (over the counter or prescibed) include medication (name, dosage) when taken (specific times, purpose.                                      
Doctor's name and contact information                                                             
Name of insurance and policy number                            
Participant is allowed to receive                 
Please list all known allergies including food, drug, latex, and insect stings:
Photo Release:  I understand that photographs of participants are taken during BCYC activities. Images including my child/the participant may be published by the Bandon Community Youth Center on Facebook, Website or printed materials.
Clear selection
Authorization for Consent to Medical Treatment          

Any individual under the age of 18 years without a completed Consent to Medical Treatment form on file prior to the start of camp will not be able to participate in any camp activity. The directors and staff are not responsible for any medical, dental or other expenses resulting from accidents.I hereby authorize the Bandon Community Youth Center Summer Camp staff to consent to any diagnostic procedure (including x‐rays), to the administration of any medical or surgical treatment, or to any hospital care when any, or all are rendered under the general supervision of any physician and/or surgeon licensed under the provisions of Oregon Revised Statute 677, the Medical Practice Act.  My child/the participant is in good health and I know of no medical reason why he/she cannot participate in any camp activities.  This authorization is given in advance of any specific diagnosis, treatment or medical care being required. By typing your name you are agreeing to the above.
I allow Participant, to participate in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death.  I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document.  I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made by me. Please type your name to agree.
I the parent or guardian of the participant understand that additional signed forms are required as well as payment to complete registration. Please type your name to agree.
Additional Comments
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bandon Community Youth Center. Report Abuse
Google Forms