Registration Form St. Peter Catholic Church

386-748-4663

Camprockdeland@gmail.com Camper’s Information (Entering Kindergarten to 8

th Grade)

________________ Child’s Last Name

______________

First Name

___________ Date of Birth

______

Age

Family Information

Parent/Guardian Name___________________________________________________________

Address_______________________________________________________________________

Telephone: Day:_______________ Cell_________________ Email:______________________

Name of person(s) with permission to pick-up child:

__________________________________________Relationship to Child__________________

__________________________________________Relationship to Child__________________

__________________________________________Relationship to Child__________________

Weeks Attending:

______June 04 - 08 ______ July 09 – 13

______June 11 – 15 Vacation Bible School ______ July 16 – 20

______June 18 – 22 ______ July 23 – 27

______June 25 – 29 ______ July 30 – August 03

______July 02 – 06 (No Camp July 4) ______ August 06 – 10

Fee: $ 75.00 per week for 1 child. ($60.00 per week for each additional child in family

attending) Camp fee payable Monday morning each week. Scholarships are available on a need

basis. ----------------------------------------------------------------------------------------------------------$20.00 Registration Fee (includes Camp T-shirt) must accompany form. Please return registration packet to St. Peter Church Office. (All forms must be present to secure registration.)

T- Shirt Size: Youth: S___M___L___XL___ /Adult: S___M___L___XL___

Conduct and Discipline Policy Camp Rock

Thank you for enrolling your child at Camp Rock. It is our intention to provide your child with a fun, safe and secure environment. In order to ensure the quality of this program and safety of the campers, each participant must follow program rules.

Every parent/guardian is required to read the following information to his/her camper and sign and return the conduct Discipline Policy Form to camp. (This must be on file prior to the start of camp).

Campers are encouraged to practice social skills that will allow them to resolve conflicts and meet their needs without the use of harmful or destructive behaviors. When disciplinary situations occur that requires intervention, camp staff provides the child with clear explanations as to why specific behavior is inappropriate. They then help him/her find alternative behavior that fits within the camp guidelines of appropriate behavior. These guidelines revolve around concerns for the safety of all members in camp.

Summer Camp Program Community Agreement Campers shall agree to: 1. Follow instructions by camp staff promptly to ensure safety. 2. Show respect to all campers, staff, equipment and property. No put downs, insults, or

teasing is allowed. 3. Keep hands, feet, head and other body parts to yourself unless part of an activity led by

camp staff. Fighting, hitting, theft, destruction of camp property, etc. WILL NOT BE TOLERATED.

4. Not run away from staff supervision or leave the camp premises without parents/guardian 5. Appropriate language and dress at all times. 6. Maintain a positive attitude and have a fun summer

Staff Discipline Response (Six Steps) 1. Verbal Warning

2. Time Out/Activity Privilege Withheld.

3. 1st Parent Contact (Parent/Guardian will be notified at pick-up or by phone call that

their child has violated a rule of the community agreement and parent will be aware of further disciplinary action that may occur if child continues misbehavior)

4. Parent is asked to Pick-Up Child and be Sent Home: (Parent/Guardian will be contacted

to pick up their camper immediately and the child will be suspended from camp for the remainder of the day. Parents will also receive an “Incident Report” by mail or email within one business day.

5. Camper is Sent Home with Suspension: (Parent/Guardian will be contacted to pick up their

camper immediately and the child will be suspended from camp for the remainder

of the day and 2 camp days after. Parents will also receive an “Incident Report” by mail or email within one business day.

6. Camper is Sent Home and Dismissed (Parent/Guardian will be contacted to pick up their camper immediately and the child will be removed from the camp program and will NOT be eligible to return during the same season. In addition, no refund will be awarded. Parents will also receive an “Incident Report” by mail or email within one business day.

Immediate Dismissal

Physical Violence is not tolerated at Camp Rock. Our staff reserves the right to dismiss a participant, whose behavior endangers the safety of themselves or others, thereby bypassing some of the disciplinary steps outlined above.

Immediate Dismissal Examples:

1. Any child who brings a weapon to camp (butterfly knife, blade, bb/airsoft gun, explosive device, etc.) will be immediately removed from the program.

2. Any child who makes a credible threat to hurt himself or others will be removed. 3. Any child who seriously harms himself or another will be removed (physical and/or

verbal abuse). 4. Any child who verbally or physically abuses staff will be removed.

Incident Reports

For any serious incident that occurs at camp, an incident report will be immediately completed by camp staff and submitted and reviewed by the Camp Director. They will then be furnished to parents for their review within one business day.

Incident Reports will contain the following:

• Date, time, place of incident

• Names of parties involved, camp staff present• A full and detailed description of incident

• Details of incident investigation: speak to parties involved, witnesses, etc.

• Signature of notification from Camp Director

• Corrective plan of action decided

*All conversations with parents regarding incidents will be kept confidential.

I have discussed the rules and consequences of the Conduct & Discipline Policy with my child and they understand what is expected from them at camp. (The Conduct and Discipline policy is posted on our website. Please refer to it with any questions or concerns.)

___________________________________ Camper’s Name (Print)

___________________________________ ____________________________ Parent/guardian Signature Date

____________________________________________________

DIOCESE OF ORLANDO FIELD TRIP PERMISSION FORM

I am the parent/guardian of ________________________ and I give my permission for

my child to travel in a school bus to attend the field trips during the Camp Rock weeks

my child is signed up for. My child also must comply with Camp Rock’s field trip rules

and procedures. By granting this permission, I also waive any claims against, and

release and hold harmless, Camp Rock, St. Peter Catholic Church, the Diocese of

Orlando, and any of their religious, employees, volunteers, agents, and representatives,

from any harm that occurs to my child while participating in the field trip.

In the event my child requires medical treatment or transportation for medical care,

Camp Rock will attempt to contact me at the number(s) listed on the registration form. If

they are unable to reach me, they may contact the designated emergency contact at the

number(s) listed on the Medical Information and Consent Form. If the chaperones,

volunteers, or other adult supervisors are unable to reach the designated emergency

contact, I authorize them to take appropriate measures to provide care and treatment for

my child, to transport my child to the nearest emergency room or physician's office, or to

call an emergency paramedic ambulance service.

Parent/Guardian's Signature _________________________________________

Date __________________