CHA Camp Explorations 2017

Please use a separate form for each child you register for camp.  If you have any questions, please email or call 425-372-2800.  Please send the $50 registration fee (if applicable) to Chestnut Hill Academy, 13633 SE 26th St. Bellevue, WA  98005.

General Information

Parent/Guardian's Signature

Cancellation Policy

Enrollment changes must be made at least one full week (preferably more) in advance, in writing (email acceptable), by Friday at 5 PM. I understand that I will be charged for the full week of camp if I cancel with less than a week’s notice or if my child is enrolled and I then choose not to bring him/her to camp.

Parent/Guardian's Signature

Parent/Guardian's Information
Emergency Contact 1
Camp Information

To ensure you receive the School’s Out camp rate, please complete the reservation process utilizing the following link after you have submitted this registration form -

Photo and Video Permission

Bright Horizons takes photographs and videos of children enrolled in its programs on a regular basis for its business purposes. Bright Horizons retains all rights, title, and interest in these materials and may use and disseminate them in a variety of ways, in its sole judgment. Bright Horizons takes care that any use, display, or dissemination of photographs or videos of children, whether at a particular school where the child attends or for its general business purposes, is accomplished in a thoughtful, safe, and secure manner appropriate under the particular circumstances.

For example, at your camp or school, these materials may be used to better communicate with families and to illustrate the daily curriculum, to chronicle a child’s development, or to document activities. These photos may be shared with you and other families on a secure Bright Horizons website, on Facebook, by e-mail, posted in the school, or in a parent newsletter.

By signing below, I give permission to Bright Horizons to take photographs and videos of my child during his/her enrollment and to use these materials for its business purposes. May we use photographs of your child on our marketing materials for camp?

Parent/Guardian's Signature

Field Trip and Walks Permission

As part of the program, children will go on walks in the surrounding area supervised by the staff, weather permitting. A separate Field Trip Policies and Permission Slip describing the field trip will be sent home if your child will be leaving the school for an extended period of time. I hereby give my permission to Chestnut Hill Academy to remove my child from the premises for neighborhood walks, visits to the playground or park, by means for off-campus field trips requiring transportation.

Parent/Guardian's Signature

Illness, Injuries and Medical Conditions

Child Illness
In case of illness, I will be called and possibly required to pick up my child(ren) as soon as possible. We ask that for your child’s comfort and to reduce the risk of contagion, children be picked up within 1.5 hours of notification. Until then, your child will be kept comfortable and will continue to be observed for symptoms. Children need to remain home for 24 hours without symptoms before returning to the program. This means that the child needs to remain out of the school for the remainder of the day he/she is sent home and the following day (if a child is sent home on Friday, he/she may return on Monday), unless the school receives a note from the child’s medical provider stating that the child is not contagious and may return to the school. In the case of a (suspected) contagious disease, rash, or continuing symptoms, a note from the child’s medical provider may be required before returning.

Children’s Injuries
If my child sustains a minor injury (e.g. scraped knee) during care, I understand that I will receive an Incident Report outlining the incident and course of action taken by the staff member when I arrive to pick up. I will be contacted immediately if the injury produces any type of swelling, is on the face or head, or needs medical attention.

Emergency Medical Care
Every effort will be made to contact me in the event of an emergency requiring medical attention for my child. If I cannot be reached, the emergency contacts listed on the previous page will be called. I authorize Bright Horizons to call an ambulance to transport my child to a hospital or medical facility and to secure for my child the necessary medical treatment. Staff is trained in the basics of first aid and CPR and I authorize them to give my child first aid. In a school, any member of the staff responsible for the care and education of my child may view my child’s health information, as well as state licensors for compliance purposes.

Medical Conditions
If your student has a medical condition or illness (other than asthma or allergies) that requires medication we will need you to submit an 'Individual Health Care Plan' and an 'Administration of Medicine' authorization form. Both forms need to be signed by your primary care provider and are required before your child comes to school, along with the medication which must be in date. If your child has allergies or asthma please complete the Asthma and / or Allergy Care Plan. You can download the forms here

Parent/Guardian's Signature

Medical Information and Authorization Section
Family Doctor
Family Dentist

If yes, you must complete an Allergy Healthcare Plan and any relevant Medication Authorization forms which you will find here

If yes, you must complete an Asthma Healthcare Plan and any relevant Medication Authorization forms which you will find here

Medical Insurance
Nut Safe Policy

Chestnut Hill Academy is a nut safe zone, as peanuts and tree nuts can cause severe and sometimes life-threatening reactions. In order to maintain a safe environment for all students, nuts and items containing nut ingredients may not be brought onto campus premises. Please check ingredient labels on all food items, as well as lotion and lip balm items, to ensure that the item does not contain nut ingredients or traces of nuts. Only sealed products with ingredient labels verifying there are no nuts, no nut products, and no potential traces of nuts from the equipment used for processing will be served to the children. While coconut is identified by the FDA as a tree nut, few incidences of allergic reactions to coconut are documented, and coconut may be considered the exception to the nut safe rule above. If you pack a lunch for your child which contains nuts, it will be removed, your child will be given a school lunch and you will be contacted.

Parent/Guardian's Signature

Sunscreen and Insect Repellent

Sunscreen and insect repellent should be applied to a child at least once at home to test for any allergic reaction. Aerosol sprays and combined sunscreen and insect repellent are prohibited. Sunscreen/sunblock must provide UVB and UVA protection with an SPF of 15 or higher.

Insect repellent may only be used if recommended by public health authorities or requested by a parent/guardian. The repellent must contain a concentration of 30% DEET or less and may be applied no more than once a day.

All sunscreen/sunblock and insect repellent provided by a parent/guardian must be:
• provided in the original container;
• clearly labeled with the child’s full name;
• within the expiration date; and
• appropriate for the age of the child.

Please include the brand name of insect repellant and any special instructions for application.

Parent/Guardian's Signature

Please include the brand name of sunscreen and any special instructions for application.

Parent/Guardian's Signature

Weekly Theme Selection

Please choose your child’s club choice for each week he/she will attend Camp Explorations. K-1 is for Kindergarten and 1st graders; 2-3 is for 2nd & 3rd graders; 4-6 is for 4th – 6th graders. If we cannot enroll your child in your club of choice, you will be contacted.

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