Camp Rigolo Registration Form - School Web sites hosted by ...

Camp Rigolo Registration Form
French Immersion Summer Day Camp
Current Grades K-4
July 14-18, 2008
PLEASE PAY BY CHECK ONLY, PAYABLE TO SEHS French Immersion. Camp Rigolo fees are
$150.00 for the week. Full payment is due by June 6, 2008. Number of campers is limited—so register
early!! Return this Registration Form to the Fox Hollow office.
___________________________________________________________________________ M F _______________
Student Name gender grade (now)
______________________________________________________________________________________________________
Address City Zip
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T-Shirt size: (circle one) YM YL AS AM AL (Y=youth; A=adult)
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Home Information:
______________________________________________________________________________________________________
Mother/Guardian email home phone work phone
______________________________________________________________________________________________________
Father/Guardian email home phone work phone
Permission to pick up my child: For your child’s safety, please list any persons, other than yourself, whom you authorize to
pick up your child. Your child will not be released to any person unless listed below. If your child is allowed to walk home,
we MUST have permission in writing—use name space below to give written permission to walk home.
______________________________________________________________________________________________________
1. Name phone
______________________________________________________________________________________________________
2. Name phone
Physician:__________________________________________Phone_____________Preferred hospital___________________
Please describe any health concerns regarding your child’s participation in camp (allergies, etc.) ________________________
______________________________________________________________________________________________________
Instructions for any medication your child will bring to camp (all medicine must be in its original container)_______________
______________________________________________________________________________________________________
Permission to Participate:
• I give permission for my child to participate in Camp Rigolo. I release any and all claim for damages and losses
suffered by me or my child as a result of participation in the camp against Eugene School District 4J, any employees,
officers, or agents thereof, or the adult facilitator or any of the volunteers involved.
• In the event of an emergency, I authorize any necessary medical procedure for my child.
• I authorize still photography and videotaping of my child during Camp Rigolo: Yes ______ No _______
______________________________________________________________________________________________________
parent/guardian signature date
-continued on back-

Camp Rigolo
Student Behavior Agreement
Our utmost priority is the safety and well-being of the campers. With this in mind, we require safe and responsible behaviors
from all children who choose to participate in the camp.
There are three rules that all campers must follow.
1. Show respect and courtesy toward others.
2. Follow directions the first time they are given.
3. Help provide a good learning environment for all.
It is important that we provide a safe environment for all. The following procedures will be followed if a camper chooses to
behave inappropriately:
1 st encounter – An explanation to the camper specifically detailing the behavior that was inappropriate and/or unsafe.
2 nd encounter – An explanation as well as a time out separating the camper from other campers in his/her group.
3 rd encounter – A phone call home requiring the parent to immediately pick the camper up.
Certain behaviors will be considered serious enough to warrant the immediate removal of the camper from camp. Examples of
such behaviors include: the deliberate injury to another camper, fighting, or wandering off alone. Please discuss these
behavioral expectations with your child. Sign and return the behavioral contract below your application.
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I have read the behavior expectations and agree to help make Camp Rigolo safe and fun by following the three rules listed
above.
__________________________________________________________________
Camper Signature
I agree to immediately pick up my child from Camp Rigolo if he/she isn’t able to safely participate in the Camp experience. I
will abide by the decisions made by the staff and will support their efforts in providing a safe and worthwhile experience for
my child.
__________________________________________________________________
Parent Signature
_____________________________ _____________________________ _____________________________
Home Phone Work Phone Cell Phone
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Camp Rigolo runs on the efforts of volunteers. Please contact Vicky
Magor at vmagor@comcast.net or call 343-5418 to offer your help.
I will be able to volunteer at Camp Rigolo: Yes _________ No __________
Camp Rigolo is July 14-18, 2008 I will be able to help (list days and times): ________________________________________
______________________________________________________________________________________________________
I would like to help chaperone the field trip (usually Friday) _______________________________________________
______________________________________________________ _____________________________________
Parent Signature Phone

Camp Rigolo Field Trip Permission Form
My approval is hereby given for ________________________________________________ to go on the planned field trip
to ___________________________________ on Friday, July 18, 2008.
__________________________________________ ___________________
SIGNATURE OF PARENT/GUARDIAN DATE