Day Camp

Please specify dates camper will attend *

Student Full Name (First Last) *

Student's Date of Birth (MM/DD/YYYY) *

No lunch will be served due to health concerns during COVID-19 Select all that apply Yes, I will bring own lunch

Extended Care Select all that apply Morning Care (8:30am - 9:00am) - daily (+ $5.00) Afternoon Care (4:00pm - 6:00pm) - daily (+ $10.00) Morning care + Afternoon care for After School Students (Free) We don't need this service.

Travel History Within the Past 2 Months Select all that apply My child did not have any overseas travel history within the past 2 months. My child had travelled overseas within the past 2 months. (please contact us before checkout.)

Accident Release, First Aid, Media and Financial Responsibility Wavier Select all that apply I authorize and grant permission for a representative of Champion Camp to treat minor injuries including scrapes, small cuts, splinters, and insect bites. I authorize and grant permission for a representative of Champion Camp to obtain emergency medical care from any licensed physician or hospital and/or medical clinic should my child become ill or injured. I therefore freely and voluntarily execute this release with such knowledge, assume the risk of personal injury and/or property loss arising from or in any way connected with participation in any programs offered by said child care center. I hereby release and discharge said child care center and any and all agents from any liability, claim, cause of action, demand or damages from injury or damages of any kind to my child or my property as a result of participation in the programs of Champion Camp. I grant permission and understand that photos and other images taken during this event could be used in print advertisement and other forms of media. I understand that should my child become a disruptive force during the educational program that the instructor may choose to release him/her from the program with no refund.

Allergy or other medical information (Please notice that you may store your Child's medication at Champion office and take it back when checking out Champion Camp.)

I acknowledge that I and my child will complete daily health screening upon entering the facility, and my child will wear masks at all time.. Select all that apply Yes No (Please contact us office@champion-education.com)