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