EmailMe Form - Summer 2022 Camp Registration Little Theater

Child's Name *

First Last

Covid Vaccination *

My child is vaccinated

My child is not vaccinated because they are under 5 years old and cannot be vaccinated at this time

My child is over 5 and is not vaccinated

Age *

Birthdate *

Grade *

Camp you are registering for: *

June 6 - Little Mermaid Little Theater 4 -8 years

June 13 - Lion King 1st-5th

June 20 - Peter Pan Little Theater 4-8 years

June 27 - Frozen Little Theater 4-8 years

July 5- Mary Poppins Little Theater 4yrs-8years

July 11 - Willy Wonka Little Theater 4yrs-8years

July 18th - Mary Poppins Little Theater 4yrs-8years

July 25 - Wizard Of Oz 1st -5th

August 8- Little Mermaid Little Theater 4-8 years

Additional Camps We Would Like to be WAITLISTED

Week/Camp Name

Refunds *

I agree to the terms listed: Summer Camp Full Refund by Feb 1, 2022 minus a $25.00 processing fee. 50% refund by March 1, 2022 minus a $25.00 processing fee. No refunds after March 1, 2022 unless we can find someone to take your spot with $25 fee

Illness Policy *

I agree to the following: If your child is ill with contagious symptoms, you may attend another summer camp as space allows with 24 hours notice. If your child has proof of Covid, we will give you full credit to use at a later time.

CONTACT INFORMATION

Family Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Primary Parent Contact *

First Last

This person is the parent that should be contacted if there is confusion at pick-up time or about billing concerns.

Phone *

### - ### - ####

Primary Parent's Email *

Secondary Parent Contact

First Last

Phone

### - ### - ####

MEDICAL / DENTAL INFORMATION

Covid Vaccine Status

Camper is not eligible to have the vaccine

Camper is fully vaccinated

Camper is partially vaccinated

Camper is not vaccinated

This is optional but is helpful for us if we have an active covid case and have to inform parents.

Special Needs *

I understand it is my responsibility to contact the office prior to enrolling if my child has special needs that may require additional support. Failure to do so may result in needing to withdrawl from the camp without a refund option

Special needs include but are not limited to: physical limitations, challenges using the restroom, impulse control issues, ADHD, developmental delays, etc.

OFF SITE WALKING EXCURSION FOR PICNIC LUNCH

Permission to walk one block to the grassy area at Laurel School for eating *

Yes - I give my permission for my child to participate

Campers are strictly supervised to stay on the sidewalk. This allows for safe outdoor socially distant eating. Alternatively, we may have access to a tented/fenced parklet if we get city permission

POLICIES REGARDING REDUCING THE RISK OF COVID-19 TRANSMISSION

Adult Mask Requirement *

Yes - I understand and agree to adhering to this policy

All adults are required to wear a mask during check in

Only campers are allowed in the facility and back yard. *

Yes - I understand and agree to adhering to this policy

Unless there is an extenuating circumstances, family members of campers must not enter the facility

Social Distancing Requirement *

Yes - I understand and agree to adhering to this policy

Adults will be asked to adhere to staying 6ft apart from others and model the same expectation for their children.

Illness Policy *

I understand and agree to adhering to this policy

- If your child is sick, exact symptoms need to be reported immediately.
- Campers showing any signs of illness (congestion, runny nose, sore throat, stomach discomfort, headache) must not attend and need to get clearance from a doctor and / or a negative Covid test to return
- Mid-day illness: Children will have to picked up immediately if they show signs of illness mid-day
- We must be notified immediately if any member of the family or the camper has been diagnosed with Covid

Quarantine Policy *

I understand and agree to adhering to this policy

I will inform you immediately if my chlld has had potential exposure to Covid and will quarantine for the period required by current Alameda County Health Department guidelines

Commitment to Following Safety Protocols *

Yes - I understand and agree to adhering to this policy

- I understand that if any family members refuse to adhere to our protocols after being reminded, they risk the child being dismissed from the program without advanced notice. Documentation of the reminder provided and policies not followed will be provided. No refunds will be provided if asked to leave the program
- Children will be taught safety guidelines for participating in our program. We understand that they will not always remember but must always be willing to follow directions when reminded. If they seem to have difficulty with following directions and we feel it may potentially compromise the health of others in the program, the family will be notified and if not improved dismissal from the program is possible. Under these circumstances, refunds will not be provided.

Behavior Policy *

I understand the behavior policy and understand that my child may be removed from the program without a refund for severe or repeated violations of the policy.

In the interest of creating a safe and fun for campers, all are required to follow staff directions, act respectfully to staff and other campers, not compromise the emotional and physical safety of others and follow Covid safety protocols. Parents will be informed if a camper has been unable to meet these expectations and a behavior plan will be implemented allowing for no more than 3 violations. If the behavior does not improve Onstage Kids N Dance N Theater Arts has the right to remove the camper from the program with no refund. Severe violations may warrant immediate removal with implementation of a behavior plan.

ALMOST THERE ......

Payment Required to Complete Enrollment READ CAREFULLY *

I understand that I will be directed back to the website to select the camp. I will need to scroll through the camp descriptions, find my camp, and press the "sign up button" to pay

Setting up a Mind Body Account *

I understand that in order to pay I will be directed to set up a Mind Body Account (if you do not already have one) I UNDERSTAND I NEED TO SET THE ACCOUNT UP UNDER EACH CHILDS NAME SEPARATELY. PARENT'S NAMES SHOULD NOT BE USED.

Signature

IMPORTANT

Completing this form DOES NOT mean you have registered for for the camp. ENROLLMENT IS COMPLETE ONLY AFTER PAYMENT IS MADE *

Clear

Your signature indicates agreement to our registration terms It also signifies consent for items indicated in this completed form.

Printed Name *

First and Last Name of person that completed the form and signed above.