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Camp Information for Non CHA Families

Required

You only need to fill this form in once, but you do need to fill in a separate form for each child you register for camp. Incoming families are also required to fill in the COVID Informed Consent Form. Please keep your email confirmation in case you need to edit this form. If you have any questions, please email camp@chestnuthillacademy.com or call 425-372-2800.  
Must contain a date in M/D/YYYY format
Genderrequired
Grade in Sept. ’22required
Has child attended Camp Explorations before?required
Cancellation Policy

Enrollment changes for Daily/ Weekly Camp must be made at least two full weeks in advance, in writing (email acceptable), by Friday at 5 PM. I understand that I will be charged for the full week/day of camp if I cancel with less than 2 weeks notice, or if my child is enrolled and I then choose not to bring him/her to camp.

By typing my name in the box below I acknowledge that I have read and will abide by the cancellation policy. 

Must contain a date in M/D/YYYY format
Parent/Guardian's Information
Namerequired
First Name
Last Name
Other Parent/Guardian's Name
First Name
Last Name

Emergency Contact 1

Namerequired
First Name
Last Name

Emergency Contact 2

Name
First Name
Last Name
Photo and Video Permission

Chestnut Hill Academy takes photographs and videos of children enrolled in its programs on a regular basis for its business purposes. Chestnut Hill Academy retains all rights, title, and interest in these materials and may use and disseminate them in a variety of ways, in its sole judgment. Chestnut Hill Academy 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 Chestnut Hill Academy website, on Facebook, by e-mail, posted in the school, or in a parent newsletter.

By signing below, I give permission to Chestnut Hill Academy to take photographs and videos of my child during his/her enrollment and to use these materials for its business purposes.

Must contain a date in M/D/YYYY format
May we use photographs of your child on our marketing materials for camp?required
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.

Field Trips and Walksrequired
Must contain a date in M/D/YYYY format
Parent/Guardian Consent

By registering my child for camp, I agree to pay all fees associated with the sessions in which he/she becomes enrolled by the deadlines indicated for Camp Explorations. I also agree that my child must follow the rules of Chestnut Hill Academy and understand that he/she may be withdrawn from the program at the sole discretion of the school if these rules are violated, without refund of fees. I further consent to my child being treated for any medical emergency which might occur. I agree to pay the $50 registration fee if applicable, refundable only if my child is unable to be placed in any of the classes I have selected. I understand that by not choosing an Extended Day option, I agree to drop off my child no earlier than 9:00 a.m. and pick them up no later than 4:00 p.m. I further understand that I will be charged a fee of $20.00 per hour if my child attends Extended Day. I understand I must cancel my child’s camp(s) in writing at least two weeks in advance or I will be billed for the full week. I have read, understand, and accept the conditions noted above.

Parent/Guardian Consentrequired
Must contain a date in M/D/YYYY format
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 at the bottom of this page http://www.chestnuthillacademy.com/campus-life/camps

Consent for Treatmentrequired
Must contain a date in M/D/YYYY format
Medical Information and Authorization Section
Allergiesrequired
If the answer is yes, and your child is not already enrolled in CHA, you must complete an Allergy Healthcare Plan and any relevant Medication Authorization forms which you will find at the bottom of the Summer Camp information page - https://www.chestnuthillacademy.com/campus-life/camps
Asthmarequired
If the answer is yes, and your child is not already enrolled in CHA, you must complete an Asthma Healthcare Plan and any relevant Medication Authorization forms which you will find at the bottom of the Summer Camp information page - https://www.chestnuthillacademy.com/campus-life/camps
Must contain a date in M/D/YYYY format

Food Preferences

Please list below any foods your child should not be served due to cultural/religious/vegan or vegetarian reasons but excluding medical causes (i.e. allergies) or personal preferences (i.e. dislike of certain foods). Where possible, CHA offers vegetarian options, but cannot make accommodations for all allergies, or food preferences based on religious or cultural beliefs or family lifestyle. In such cases, it is up to each family to accept our meal/snack choices for your child or to send food from home. If your child cannot eat the meat or vegetarian meal provided on any given day due to allergies or dietary restrictions, they should bring “nut-safe” food from home and should not place an order for that day.

I understand that CHA cannot guarantee that my child will not be exposed to a particular food and that any changes to the preferences listed above must be made by me in writing. By typing my name in the box below, I acknowledge that I am signing this form.

Must contain a date in M/D/YYYY format
Informed Consent
A school is a community. During this public health emergency, EACH member of our community needs to help keep COVID-19 out of our school. Exposures can lead to the closure of the entire school and impact all the families we are serving. We appreciate your partnership and commitment to this collective effort. All families are required to complete the form you will find here.
 
By typing my name in the box below I certify that I have completed the Informed Consent form
Must contain a date in M/D/YYYY format
Consent for Child Release

To ensure children’s safety, CHA will release a child only to the parent(s) / legal guardian(s) who have signed this form and to those listed below as undersigned by the parent/guardian.

By signing this form, I understand that CHA will not release my child to any other person unless I notify them in advance, following the guidelines listed below:

  • If the person (spouse, relative, friend) picking up my child is listed on this form, I must notify CHA verbally.
  • If the person picking up my child is NOT listed on this form, I must notify CHA in writing.
  • Photo identification will be required of any person picking up my child.

By typing my name in the box below I acknowledge that I am signing this form

Must contain a date in M/D/YYYY format
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.

By typing my name in the box below I acknowledge that I have read and understood the nut safe policy.

Must contain a date in M/D/YYYY format
Camp Fees required

Payment Information

Please select a payment typerequired
Billing Addressrequired
Cardholder Namerequired
Expirationrequired