Camp Hiawatha
1601 W. 51st St. N. Wichita, KS 67204 (316) 838-7871
Camp Hiawatha Registration Form 2017 CAMPER’S INFORMATION
First Name: __________________________________________ Last Name: _______________________________________________________ Mailing Address: __________________________________________ City: _________________________ State: ___________ Zip: __________ Home Phone: (______) ___________________________ E-mail Address: __________________________________________________________ Birth date: _______/________/__________
Male: ______ Female: ______
School Grade for Fall 2017: _______________________
Camper attends school at : _______________________________________________________________________
T-Shirt Size: (circle one)
Camper attends church at: _______________________________________________________________________
Child: 6/8 10/12 14/16
(Church Name / City)
Referred to camp by: ______School Flyer ______I am a returning camper
______friend (name of friend________________________________) Adult: S
______Mail Flyer
M
L
XL
______Other (please specify________________________________________) EMERGENCY INFORMATION
Mother or Legal Guardian’s Name: ___________________________________Employer: ________________________________ Mailing Address: __________________________________ City: ___________________ State: _________ Zip: ______________ Telephone | Home: (_____) ____________________ Work: (_____) ____________________ Cell: (_____) ___________________ Father or Legal Guardian’s Name: ___________________________________Employer: ________________________________ Mailing Address: __________________________________ City: ___________________ State: _________ Zip: ______________ Telephone | Home: (_____) ____________________ Work: (_____) ____________________ Cell: (_____) ___________________ Other Emergency Contact:_____________________________________________Relationship to camper: ___________________ Mailing Address: __________________________________ City: ___________________ State: _________ Zip: ______________ Telephone | Home: (_____) ____________________ Work: (_____) ____________________ Cell: (_____) ___________________ CHOOSE CAMP DATES Mark an “X” in the boxes of the weeks your child will attend Cost: $125 for each week
1 5/30-6/2 *Closed Memorial Day
2 6/5-6/9
3 6/12-6/16
4 6/19-6/23
5 6/26-6/30
6 7/3-7/7 *Closed July 4th
7 7/10-7/14
8 7/17-7/21
9 7/24-7/28
10 7/31-8/4 *Day Camp is only for 1-4 grades
Day Camp
Overnight Camp
5-6 grade
YES NO I give permission for my child to participate in swimming activities supervised by certified lifeguards.
Monday Tuesday Wednesday Thursday Friday
____ to ____ ____ to ____ ____ to ____ ____ to ____ ____ to ____
*Please note hours of operation are 7 am to 5:30 pm.
Overnight Camp JH
YES NO I give permission for photos of my child to be used for promotional & programming purposes. If not, then please attach photo of your child.
Anticipated days & hours of Day Camp attendance.
YES NO I give permission for my child to participate in Camp Hiawatha’s climbing wall and zip line with proper certified staff supervision. Safety equipment will be worn. YES
NO
I give permission for my child to participate in archery with proper certified
staff supervision.
I understand that Camp Hiawatha is a Christian camp and lessons will be taught from The Bible. I understand that if my child does not participate in the camp program, adhere to camp policies, or is involved in misconduct, he/she may be sent home without refund. I have read and understand the Camp Registration Instructions & Payment Policies from the second page of this form. ________________________________________________________________________________________________________________________
Signature of Parent / Legal Guardian
_____________________________________________________
Date
2017 CAMP REGISTRATION INSTRUCTIONS & PAYMENT POLICIES DAY CAMP INSTRUCTIONS ONLY
Complete registration form, health forms, and emergency authorization. School grades listed refer to the grade for the fall of 2017. Registration form MUST be signed by the parent or legal guardian. Please make a copy for your personal reference. Plan to attend the parent meeting for information regarding camp policies and what to bring to camp. A Deposit of $125 (equal to the fee for one week’s camp) is required to hold your child’s reservation. These funds will be applied to your last week of day camp. Each week’s payment is due no later than the Monday prior to the week attended. Please note the dates for which you have registered. A two week notice is required to change dates at no cost to you. There will be no refund for no-shows. Register early! There may be a limited number of spaces available this year.
REGISTRATION INSTRUCTIONS FOR ALL OTHER CAMPS
Fill out the forms completely with accurate information. Incomplete information will slow down the registration process. Payment for overnight camps needs to be made in full at the time of registration. School grades listed refer to the grade for the fall of 2017. Please select camps for the appropriate grade level. Registration form MUST be signed by the parent or legal guardian. A confirmation letter will be mailed two weeks before Overnight camp begins. This will include information about what to bring to camp, as well as arrival and departure times. After completing the registration and health forms, make a copy for future reference. Registrations will not be made over the phone.
CANCELLED REGISTRATIONS & REQUESTS TO CHANGE CAMPS:
Full refund: 15 days or more before camp’s start date. No refund for changes or cancellations made 2 weeks or less before camp’s start date.
Full refund given if a camp is full or cancelled by Camp Hiawatha.
g
HELPFUL REMINDERS: Register early! Some camps may fill up quickly. Campers/parents are responsible for transportation to and from camp. Any questions? Contact Kim Herrman (316) 838-7871 [email protected]
n eeti M nt are attend. P y to r
to an nda lease pl , 7 pm a M P y 25 Ma
OR 9 am d 27, y age Ma our
nc re e d a n n ldre to atte Chi
PAYMENT INSTRUCTIONS
Send payment along with necessary forms. (Please note: we do not have the ability to accept credit/debit cards at this time) Make checks payable to CAMP HIAWATHA. Mail to: 1601 W. 51st Street N. Wichita, KS 67204
Camp Hiawatha Registration Form 2017 CAMPER’S INFORMATION
First Name: __________________________________________ Last Name: _______________________________________________________ Mailing Address: __________________________________________ City: _________________________ State: ___________ Zip: __________ Home Phone: (______) ___________________________ E-mail Address: __________________________________________________________ Birth date: _______/________/__________
Male: ______ Female: ______
School Grade for Fall 2017: _______________________
Camper attends school at : _______________________________________________________________________
T-Shirt Size: (circle one)
Camper attends church at: _______________________________________________________________________
Child: 6/8 10/12 14/16
(Church Name / City)
Referred to camp by: ______School Flyer ______I am a returning camper
______friend (name of friend________________________________) Adult: S
______Mail Flyer
M
L
XL
______Other (please specify________________________________________) EMERGENCY INFORMATION
Mother or Legal Guardian’s Name: ___________________________________Employer: ________________________________ Mailing Address: __________________________________ City: ___________________ State: _________ Zip: ______________ Telephone | Home: (_____) ____________________ Work: (_____) ____________________ Cell: (_____) ___________________ Father or Legal Guardian’s Name: ___________________________________Employer: ________________________________ Mailing Address: __________________________________ City: ___________________ State: _________ Zip: ______________ Telephone | Home: (_____) ____________________ Work: (_____) ____________________ Cell: (_____) ___________________ Other Emergency Contact:_____________________________________________Relationship to camper: ___________________ Mailing Address: __________________________________ City: ___________________ State: _________ Zip: ______________ Telephone | Home: (_____) ____________________ Work: (_____) ____________________ Cell: (_____) ___________________ CHOOSE CAMP DATES Mark an “X” in the boxes of the weeks your child will attend Cost: $125 for each week
1 5/30-6/2 *Closed Memorial Day
2 6/5-6/9
3 6/12-6/16
4 6/19-6/23
5 6/26-6/30
6 7/3-7/7 *Closed July 4th
7 7/10-7/14
8 7/17-7/21
9 7/24-7/28
10 7/31-8/4 *Day Camp is only for 1-4 grades
Day Camp
Overnight Camp
5-6 grade
YES NO I give permission for my child to participate in swimming activities supervised by certified lifeguards.
Monday Tuesday Wednesday Thursday Friday
____ to ____ ____ to ____ ____ to ____ ____ to ____ ____ to ____
*Please note hours of operation are 7 am to 5:30 pm.
Overnight Camp JH
YES NO I give permission for photos of my child to be used for promotional & programming purposes. If not, then please attach photo of your child.
Anticipated days & hours of Day Camp attendance.
YES NO I give permission for my child to participate in Camp Hiawatha’s climbing wall and zip line with proper certified staff supervision. Safety equipment will be worn. YES
NO
I give permission for my child to participate in archery with proper certified
staff supervision.
I understand that Camp Hiawatha is a Christian camp and lessons will be taught from The Bible. I understand that if my child does not participate in the camp program, adhere to camp policies, or is involved in misconduct, he/she may be sent home without refund. I have read and understand the Camp Registration Instructions & Payment Policies from the second page of this form. ________________________________________________________________________________________________________________________
Signature of Parent / Legal Guardian
_____________________________________________________
Date
2017 CAMP REGISTRATION INSTRUCTIONS & PAYMENT POLICIES DAY CAMP INSTRUCTIONS ONLY
Complete registration form, health forms, and emergency authorization. School grades listed refer to the grade for the fall of 2017. Registration form MUST be signed by the parent or legal guardian. Please make a copy for your personal reference. Plan to attend the parent meeting for information regarding camp policies and what to bring to camp. A Deposit of $125 (equal to the fee for one week’s camp) is required to hold your child’s reservation. These funds will be applied to your last week of day camp. Each week’s payment is due no later than the Monday prior to the week attended. Please note the dates for which you have registered. A two week notice is required to change dates at no cost to you. There will be no refund for no-shows. Register early! There may be a limited number of spaces available this year.
REGISTRATION INSTRUCTIONS FOR ALL OTHER CAMPS
Fill out the forms completely with accurate information. Incomplete information will slow down the registration process. Payment for overnight camps needs to be made in full at the time of registration. School grades listed refer to the grade for the fall of 2017. Please select camps for the appropriate grade level. Registration form MUST be signed by the parent or legal guardian. A confirmation letter will be mailed two weeks before Overnight camp begins. This will include information about what to bring to camp, as well as arrival and departure times. After completing the registration and health forms, make a copy for future reference. Registrations will not be made over the phone.
CANCELLED REGISTRATIONS & REQUESTS TO CHANGE CAMPS:
Full refund: 15 days or more before camp’s start date. No refund for changes or cancellations made 2 weeks or less before camp’s start date.
Full refund given if a camp is full or cancelled by Camp Hiawatha.
g
HELPFUL REMINDERS: Register early! Some camps may fill up quickly. Campers/parents are responsible for transportation to and from camp. Any questions? Contact Kim Herrman (316) 838-7871 [email protected]
n eeti M nt are attend. P y to r
to an nda lease pl , 7 pm a M P y 25 Ma
OR 9 am d 27, y age Ma our
nc re e d a n n ldre to atte Chi
PAYMENT INSTRUCTIONS
Send payment along with necessary forms. (Please note: we do not have the ability to accept credit/debit cards at this time) Make checks payable to CAMP HIAWATHA. Mail to: 1601 W. 51st Street N. Wichita, KS 67204
