Jump Camp 2021 Registration

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Please read this form carefully and complete it in its entirety. In order for Jump Camp to be permitted to run this summer, regulations must be in place for the safety of campers, staff, and families. These safety measures will also allow us to use the District facilities. I apologize in advance for the length of this form. If you have any questions, email Scott Cutaiar at cutaiar.scott@bcsdk12.org.

Email *

Camper #1 First and Last Name (See below if registering more than one child in the case of siblings) *

Camper #2 First and Last Name (skip this question if only registering one camper)

Camper #3 First and Last Name (skip this question if only registering one camper)

Camper's School *

Grade Camper is Entering *

Allergies

Shirt Size (Adult Sizes) (See the next question if you are registering more than one camper)

XXL

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Shirt Size - If you are registering more than one camper (in the case of siblings), please put names and shirt sizes below. If you are registering only one camper, skip this question.

Parent Name(s) *

Parent Cell Phone #1 *

Parent Cell Phone #2

Street Address *

City/Town *

Zip Code *

Emergency Contact #1 Name *

Emergency Contact #1 Cell Number *

Emergency Contact #2 Name

Emergency Contact #2 Cell Number

Past Injuries that have taken camper out of sports or anything you'd like camp staff to know.

I acknowledge that I will prescreen my child prior to every Jump Camp session. If my child has a fever, chills, cough, shortness of breath or difficulty breathing, unusual fatigue, unusual muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea, I will not send my child to Jump Camp. *

I Agree

Required

I acknowledge that if my child has had close contact with a confirmed case of COVID-19 (defined as within six feet for ten minutes), they will not return to camp until 14 days after that contact. Note - Fully vaccinated campers (two weeks past final dose) would not be subject to this requirement. *

I Agree

Required

I acknowledge that if my child tests positive for COVID-19, I will inform Scott Cutaiar, Camp Director. Scott will not disclose the name of your child to anyone other than a representative of the Clinton County Health Department. *

I Agree

Required

I acknowledge that my child will be screened upon entering camp. This screening may include a temperature check. If my child has a temperature of 100.4 or higher or answers yes to any of the screening questions, they will not be permitted to enter camp and will need to be picked up. *

I Agree

Required

I acknowledge that campers who experience a fever must be fever-free for 72 hours prior to returning to camp. *

I Agree

Required

I acknowledge that my child will arrive to camp wearing a mask and will practice social distancing while at camp. Campers who do not follow the social distancing precautions will be dismissed from camp. Campers will not be required to wear a mask while exercising. *

I Agree

Required

I acknowledge that parents are not permitted at camp unless permission is requested due to medical conditions. Parents are encouraged to remain in cars and asked to follow social distancing while not in cars. Parental attendance restriction may be eased during camp. *

I Agree

Required

I acknowledge that camp sessions are limited to 80 campers and I need to sign up my child for each camp session using the Schedulicity link that will be provided prior to camp starting. Walk-in campers (campers who have not signed up for a session) will not be accepted. *

I Agree

Required

I acknowledge that participation in athletics, contact or non-contact, involves a certain amount of risk to injury or illness. Additionally, I acknowledge that my child is covered by a medical insurance policy and should any injury or illness occur while he or she is at Jump Camp, I will be responsible for any medical expenses. Knowing this, I give my child permission to participate in Jump Camp. In the event that I cannot be contacted, I give my permission for a hospital or doctor to administer treatment to my child, in the case of an emergency, while under the supervision of my emergency contact or designated Jump Camp personnel *

I Agree

Required

Payment - Please choose the payment method below that works best for you and follow the directions for payment. The cost for camp is $100 per camper, $160 for 2 siblings, or $220 for 3 siblings. *

Paypal - send payment to scottcutaiar@charter.net. Please put your child's name as a note or memo.

Mail Payment to Scott Cutaiar, 37 Addoms Street, Plattsburgh, NY 12901. Checks should be made payable to Jump Camp. Please put your child's name in the memo.

Venmo - Send payment to ScottandBethCutaiar - Please put your child's name in the message. The last 4 digits of my telephone number are 1719 if you are asked.

My child will bring the payment to Scott Cutaiar at Beekmantown Middle School this week.

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

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