CAMP ReGISTRATION FORM - International School of Indiana

isind.org

CAMP ReGISTRATION FORM - International School of Indiana

SUMMER CAMPS

A variety of camps available for all ages.

WEEK 1

JUNE 17 – 21

MORNING SESSION: 9 a.m. – noon

$150 Camp Fee

$125 (ISI Family Price)

AFTERNOON SESSION: 1 p.m. – 4 p.m.

$150 Camp Fee

$125 (ISI Family Price)

WEEK 2

JUNE 24 – 28

MORNING SESSION: 9 a.m. – noon

$150 Camp Fee

$125 (ISI Family Price)

AFTERNOON SESSION: 1 p.m. – 4 p.m.

$150 Camp Fee

$125 (ISI Family Price)

EXTENDED CARE

Morning – 7:00 – 9:00 a.m. $50 per week

Evening – 4:00 – 6:00 p.m. $50 per week

Absolutely no student should arrive prior to 7:00 a.m.

Students not picked up by 6:00 p.m. will be charged an additional fee.

For more information, please visit isind.org/campus-life/2013-summer-camps.aspx

or contact Barbara Wood at bwood@isind.org or 923.1951


Schedules

For more information, please visit isind.org/campus-life/2013-summer-camps.aspx

Week 1 June 17 - 21

9AM - 12PM

CAMP # CAMP NAME GRADE LEVEL LANGUAGE

001 Vivent les Vacances en Art 3 & 4 Year Old French

002 Fun Learning Science in Spanish 3 & 4 Year Old Spanish

003 Fun Mandarin Summer Time with Ms Kitty Kindergarten, Grades 1 & 2 Mandarin

004 Summer Time Spanish (part 1 of all day session) Kindergarten, Grades 1 & 2 Spanish

005 Sewing with Felt Kindergarten, Grades 1 & 2 English

006 Kickball Grade 3, 4 & 5 English

007 Beat Boredom with Ms Mary Kathryne Grade 3, 4 & 5 English (all levels)

008 French Cooking Grade 3, 4 & 5 French (all levels)/Enlgish

009 French Art and Music Grade 3, 4 & 5 French

010 Video Makers Grade 3, 4 & 5 Spanish (all levels) or English

011 French Culture Grade 6, 7, & 8 French

012 ISI Hoopers Grade 6, 7, & 8 French (all levels)

050 Chess Summer Camp Grade 6, 7 & 8 English

013 Court is in session (Part 1 of 2 week course) Grade 8, 9 & 10 English

014 Math SAT Review Course Grade 9, 10 & 11 English

1PM - 4PM

CAMP # CAMP NAME GRADE LEVEL LANGUAGE

015 Fun Learning Science in Spanish Kindergarten, Grades 1 & 2 Spanish

016 Vivent les Vacances en Art Kindergarten, Grades 1 & 2 French

049 Summer Time Spanish (part 2 of all day session) Kindergarten, Grades 1 & 2 Spanish

017 Spanish Art and Paintings Grade 3, 4 & 5 Spanish

018 Video Makers Grade 3, 4 & 5 Spanish (all levels) or English

019 Learning French with games, sports and songs Grade 3, 4 & 5 French

020 Beat Boredom with Ms Mary Kathryne Grade 3, 4 & 5 English (all levels)

021 Flamenco and Latin Dance Class Grade 6, 7 & 8 English

022 Worldwide Culture through Zumba Grade 6, 7 & 8 English

023 Mandarin Summer Camp with Ms Kitty Grade 6, 7 & 8 Mandarin

024 Flag Football with Mr. Robby Grade 6, 7 & 8 French (all levels)

025 Math SAT Review Course Grade 9, 10 & 11 English

051 Chess Summer Camp Grade 9, 10 & 11 English

Week 2 June 24 - 28

9AM - 12PM

CAMP # CAMP NAME GRADE LEVEL LANGUAGE

026 Vivent les Vacances en Art 3 & 4 Year Old French

027 Fun Learning Science in Spanish 3 & 4 Year Old Spanish

028 French Cooking Kindergarten, Grades 1 & 2 French (all levels)/French

029 Kickball Kindergarten, Grades 1 & 2 English

030 Sewing with Felt Grade 3, 4 & 5 English

031 Learning French with games, sports and songs Grade 3, 4 & 5 French

032 Video Makers Grade 6, 7 & 8 Spanish (all levels) or English

033 ISI Softball Camp Grade 6, 7 & 8 English

013 Court is in session (Part 2 of 2 week course) Grade 8, 9 & 10 English

1PM - 4PM

CAMP # CAMP NAME GRADE LEVEL LANGUAGE

034 Fun Learning Science in Spanish Kindergarten, Grades 1 & 2 Spanish

035 Spanish Art and Paintings Kindergarten, Grades 1 & 2 Spanish

036 Flamenco and Latin Dance Class Kindergarten, Grades 1 & 2 English

037 Vivent les Vacances en Art Kindergarten, Grades 1 & 2 French

038 French Art and Music Grade 3, 4 & 5 French

039 Video Makers Grade 6, 7 & 8 Spanish (all levels) or English

040 Flag Football with Mr. Robby Grade 6, 7 & 8 French (all levels)


ISI CAMP PARTICIPATION WAIVER, RELEASE OF LIABILITY

Camper First and Last Name: __________________________________________________________________

In consideration for allowing Camper (as identified above) to enroll and participate in a camp (“Camp”) that will involve the use of the

property and facilities of International School of Indiana (“ISI”), I/we as the parents and/or legal guardians of Camper, on our behalf

and on behalf of our Camper to the extent Camper is a minor, as well as on behalf of our and Camper’s heirs, next of kin, assigns, and

personal representatives, do hereby agree to the following conditions:

Acknowledgement of Risks: I/we understand and acknowledge that participation in the Camp and its activities including, but not

limited to, off-campus travel and field trips, are potentially hazardous activities that involve risks, inherent and otherwise, that cannot

be eliminated and which may cause injury, illness, concussion, paralysis or death to Camper or other persons and/or damage to

property. Some, but not all, of the risks associated with the Camp and Camp activities include the negligence of ISI, Camp staff and

counselors or other campers, collisions or contact with others, premises problems, equipment or vehicle failure, known or unknown

medical conditions, and improper use of equipment. I/we accept full and sole responsibility for all risks, both known and unknown,

inherent or otherwise, related to camper’s participation in the Camp and Camp activities, and acknowledge that Camper is voluntarily

participating in the Camp and Camp activities even with knowledge of these risks.

Release: Acknowledging that these and other risks exist, I/we hereby RELEASE, DISCHARGE AND COVENANT NOT TO SUE ISI,

its officers, employees, directors, trustees, representatives, managers, agents, insurers, attorneys, predecessors, successors, assigns,

camp staff, :camp counselors and/or anyone else associated in any way with Camper’s access Camp participation (the “Released

Parties”), from and against all claims, damages, injuries, losses, actions, suits, proceedings, product liability actions, wrongful death

actions, warranty actions, reach of contract actions, loss of consortium claims, expenses, and attorney fees that I/we, Camper or

anyone on our or camper’s behalf including but not limited to heirs, representatives or next of kin have or might have for any death,

injury, damage or claimed injury or damage arising out of, involving or relating to Camper’s participation in the Camp and Camp

activities, including, but not limited to, any claim that the act or omission complained of was caused in whole or in part by the strict

liability or negligence in any form of the Released Parties.

Indemnification: I/we further agree to INDEMNIFY, HOLD HARMLESS, AND DEFEND the Released Parties in any action or proceeding

from and against all claims, damages, injuries, losses, actions, suits, proceedings, product liability actions, wrongful death

actions, warranty actions, breach of contract actions, loss of consortium claims, expenses, and attorney fees that I/we, Camper or

anyone on our or Camper’s behalf (including but not limited to heirs, representatives or next of kin) have or might have for any death,

injury, damage or claimed injury or damage arising out of, involving or relating to Camper’s participation in the Camp and Camp

activities, or for our or Camper’s failure to comply with the terms of this Agreement. This agreement to indemnify, hold harmless and

defend applies even if the act or omission complained of was allegedly caused in whole or in part by the strict liability or negligence

in any form of the Released Parties.

Publicity Release: I/we authorize and irrevocably grant permission for Camper’s photograph to be used in future Camp-related

brochures, publications, newsletters, news releases, other printed materials, and in materials made available on the Internet or in other

media now known or hereafter developed.

Governing Law and Venue: This document is governed by the laws of the State of Indiana. Any cause of action relating to the

interpretation or enforcement of this document shall be instituted and litigated in a court located in Marion County, Indiana. If one or

more portions of this document are found to be unenforceable, the remainder of the document will remain enforceable.

I/we have read and fully understand this Camp Participation Waiver, Release of Liability and Medical Authorization agreement and agree

to be bound by its terms. I/we understand that by signing this document I/we are waiving certain legal rights for ourselves and for Camper,

including the right to sue the Released Parties. I/we sign this document on behalf of ourselves and Camper freely and willingly.

____________________________________________________________________________________

Mother and/or Guardian of Camper’s Signature

____________________________________________________________________________________

Father and/or Guardian of Camper’s Signature

Date

Date


MEDICAL INFORMATION AND RELEASE

Camper First and Last Name: __________________________________________________________________

Age_____________ Date of Birth: _________________________________

MEDICAL/EMERGENCY INFO:

Food Allergies: ______________________________________________________________________________

Medicine Allergies: __________________________________________________________________________

Insect Bites/Stings: ___________________________________________________________________________

Doctor Name:_________________________________ Doctor Phone: _________________________________

Emergency Contact:___________________________________ Phone: _________________________________

Medical Insurance Carrier Name: ______________________________________________________________

Phone Number:_______________________________ Policy Number: _________________________________

Current Medications: _________________________________________________________________________

Are your child’s immunizations up to date m Yes m No

Anything else we should know about your child: _________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Medical Certification: I/we hereby certify that Camper is physically fit and able to participate in the Camp and

Camp activities during the days of the camp for which Camper is registered. Any physical impairments which would

in any manner limit or affect such participation have been disclosed in writing to the Camp directors. A physiciansigned

physical release form may be required prior to or upon arrival at Camp, at the Camp’s discretion.

Medical Release: I/we authorize the ISI, the Camp Directors or others to whom Camper is referred to provide

any emergency, necessary and/or otherwise appropriate diagnostic and/or medical care during the camp

week. I/we am/are to be contacted as soon as practical after provision of such care and prior to further

diagnostic, surgical, or specialist care.

Personal Medical Insurance: ISI recommends that Camper be covered by a personal medical insurance policy.

I/we agree to be responsible for all charges (or the reimbursement thereof) for medical treatment of Camper while

at the Camp, or as a result of Camper’s participation in the Camp.

____________________________________________________________________________________

Mother and/or Guardian of Camper’s Signature

Date

____________________________________________________________________________________

Father and/or Guardian of Camper’s Signature

Date


ISI Camp Participation Agreement

Welcome to ISI Summer Camp!!!

Children must be fully registered and paid in full before they can attend the summer camp program. Please notify staff of any

changes in residence, telephone numbers, medications and or health issues as soon as possible. This will help ensure the safety

of your child. Registration includes:

• Signed Camp Participation Waiver • Medical Release Form • Payment in full

REFUND/CANCELLATION POLICY

• If ISI is responsible for the cancellation for the camp, a full refund will be issued to those that have registered for the camp.

• NO refunds will be given after the start of the camp session.

• All refund requests must be made in writing, 14 days prior to camp start day and are subject to a $20 cancellation.

• After the 14 day deadline, all refunds will not be granted without a written medial excuse from a licensed physician.

• Requests must be received from and refunds will only be issued to the individual who registered the participant.

• Behavior related dismissals are not eligible for a refund. Parents/Guardians will be notified of behavior-related issues.

• No refunds are given due to illness once the camp has started.

• All requests for refunds will be forwarded to Business Office for final approval.

CAMP HOURS

ISI Camp has 4 different sessions. Please drop your child off at the beginning of the session and pick your child promptly at the

end of the session. Only those children staying for the morning and afternoon session may stay for lunch.

Session 1 June 17–21; 9am–noon

Session 2 June 17–21; noon–4pm

Session 3 June 24–28; 9am–noon

Session 4 June 24–28; noon–4pm

Please see below for Extended Camp Care Hours. Children picked up late and not signed up for extended care or all day

camp, will be charged $10 for every 10 minutes they are late.

EXTENDED CAMP CARE HOURS

• Extended camp care hours are available from 7–9am ($50/wk )and from 4–6pm ($50/wk ).

• Any child picked up after 6pm will be assessed a late fee of $10 for every 10 minutes late.

• Same sign in and sign out process procedures as described above apply.

• All children must be registered for early drop off and late pick up.

• Same waiver policies apply for extended camp hours as for camp.

SIGN-IN / SIGN-OUT

• A daily attendance log will be kept on all participants who attend the program. Parents/Guardians must check in and out

each day to help our staff make sure all campers are accounted for.

• DO NOT take your child off the premises without checking out at the front desk.

• If a Parent/Guardian plans to pick up child before the early for any reason, the Parent/Guardian is required to send a note

and must check in at the front desk upon arrival.

• If child will be absent from camp, please call to inform staff. Remember, no refunds are given due to illness.

• When picking up your child from camp, please provide us with your driver’s license or appropriate photo ID to avoid any

problems and ensure your child’s safety. Please sign-out on the provided sign out log sheet.

ALTERNATIVE PICK UP POLICY

• In the event that someone else other than those identified on the first page of the Camp Registration Form will be picking up

your child, our staff must receive written notice. Please include person’s full name, address, phone number, birth date and

relationship to the child. Notice must be signed and dated by Parent/Guardian and returned one day in advance.

• Person picking up child will be required to show drivers license to staff and sign out the child.

• No child will be allowed to leave camp with anyone else without notice from the Parent/Guardian.

HEALTH REQUIREMENTS

• The Parent/Guardian has a responsibility to monitor the daily health and physical condition of their child and to determine

the child’s ability to actively participate in the program.

• Parent/Guardian will be notified if child becomes sick during camp.

• All minor scrapes or scratches will be treated properly and reported to the parent/guardian.

• All medical forms must be completed and turned in before the first day of camp.


DAILY MEDICATION

• We do understand that some students require daily medication.

• Bring only necessary medication to camp.

• Medication should be brought to camp in a Ziploc bag, in original packaging with instructions, clearly labeled.

• Drop off all medication with ISI Camp Staff at the beginning of each day.

• ISI will not store or be responsible for medication overnight.

SITE EMERGENCIES

• If a major or life threatening injury or accident occurs during camp, it will be handled in the following matter:

o 911 will be called immediately.

o The Parent/Guardian will be notified.

o Based on the professional decision of the EMT unit, the child may be transported to the closest medical

facility for immediate care.

• Camp has staff that is trained in first response CPR and Basic First Aid evacuation, children and staff will be

taken to local emergency room.

CLOTHING AND PERSONAL BELONGINGS

• Participants should be dressed in appropriate clothing for the summer camp program. Sneakers are appropriate for camp.

Do not wear sandals or flip flops. In advance, you will be notified if the clothing needs change (water day etc).

• All personal belongings and clothing should be clearly labeled with child’s full name.

• ISI is not responsible for any lost or stolen items. Please leave all valuables at home.

• PLEASE BRING: Sunscreen, backpack, water bottle and a packed lunch if you child is staying all clay.

• PLEASE DO NOT BRING: Sandals, Flip Flops, roller blades, scooters, wheelie shoes, money, jewelry, iPods or any other

electronic devices.

LUNCH

• Only those children who are staying for the morning and afternoon session may stay for the lunch hour (12pm–1pm). Please

pack a lunch for your child. Children will have lunch together in the school cafeteria area at the Taurel Building and will be

supervised by staff. They will also have some playtime supervised by staff. Please ensure your child has sunscreen and a hat,

so they can play outside after they have finished eating their lunch.

CAMPER BEHAVIOR EXPECTATIONS

In order to maintain a friendly and safe environment in our summer camp program, please review the following policies with your

child, to ensure that each camper will have a the most positive experience possible.

CAMPERS WILL:

• Show respect and consideration for other campers and staff.

• Have proper manners.

• Respect equipment and supplies.

• Communicate in a positive manner with other campers and staff.

• Respect the belongings of others.

• Participate in all activities.

CAMPERS WILL NOT:

• Use violence, force, intimidation, bullying or any other negative behavior towards other campers, staff and the facility.

• Use inappropriate language or name-calling.

• Destroy supplies or property.

• Bring in inappropriate items to camp (weapons etc).

Consequence of misbehavior depends on the severity of the situation and will be handled accordingly by the ISI staff.

PROCEDURE:

• Staff will address the camper(s) involved.

• Staff will communicate with the parents.

• Staff will discuss the behavior with the parents and possibility of removal from the summer camp program.


ISI Summer Camp Program

Registration Form

Camper Name: _____________________________________________________________________________

Date of Birth:_________________________ Age:____________________ Grade Next Fall:_______________

Current School: _____________________________________________________________________________

Parent(s) Name(s): ___________________________________________________________________________

Home Address: ______________________________________________________________________________

Parent Cell Number:_____________________________ Alt. Number: _________________________________

Parent Email Address:_________________________________________________________________________

Indicate Camps you would like your child to register for:

Camp Name Camp #

_____________________________________________________________________________________ $150

_____________________________________________________________________________________ $150

_____________________________________________________________________________________ $150

_____________________________________________________________________________________ $150

m Eligible for ISI Family Discount ($25 off per camp) Use Coupon Code ISICAMP (discount does not apply to extended care)

Indicate if you would like to sign up your child for Extended Care: ($50 per session)

m #045 June 17 – June 21; 7am – 9am m #047 June 24 – June 28; 7am – 9am

m #046 June 17 – June 21; 4pm – 6pm m #048 June 24 – June 28; 4pm – 6pm

Please complete payment online at: http://store.isind.org/ISI-Camps-C9.aspx

Or send check payable to:

ISI Summer Camp to International School of Indiana, 4330 Michigan Rd, Indianapolis, IN 46208

The following adults have my permission to pick up my child from camp (include relationship to child):

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

I have read, completed, understood and agree to abide by the International School of Indiana’s:

m Participation Agreement

m Medical Emergency Form and Release

m Participation Waiver and Release of Liability

____________________________________________________________________________________

Mother and/or Guardian of Camper’s Signature

Date

____________________________________________________________________________________

Father and/or Guardian of Camper’s Signature

Date

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