Please include a $10 per week deposit and the $45.00 registration fee.
Forms and payments can be mailed to:
Campapalooza
2342 Eagles Nest Rd. Jacksonville, Florida 32246.
Student’s Name: ____________________________________________ DOB: _________________________
Student’s Address:__________________________________________________________________________
City: _____________________________ State: _______________________ Zip: ________________________
Home Phone: _________________________________ Email: ______________________________________
Mother: _____________________________________ Home Phone: ________________________________
Address (If different from student: _________________________________________________________
City: _____________________________ State: _______________________ Zip: ________________________
Work Phone: _________________________________ Email: _______________________________________
Father: _____________________________________ Home Phone: ________________________________
Address (If different from student: _________________________________________________________
City: _____________________________ State: _______________________ Zip: ________________________
Work Phone: _________________________________ Email: _______________________________________
Emergency Information:
Please list all persons to be contacted in case of an emergency.
Name __________________ Relationship_________________
Phone_______________
Name __________________ Relationship_________________
Phone_______________
Name __________________ Relationship_________________
Phone_______________
Name __________________ Relationship_________________
Phone_______________
Name __________________ Relationship_________________
Phone_______________
Child's Name________________________________________________________________
Please list all persons who are authorized to pick your child up from camp.
Name ______________________
Name ______________________
Name ______________________
Name ______________________
Does your child have any food/ medication allergies, illnesses, or injuries that we should be
aware of? Y
N
If yes please explain. ________________________________________________________
_________________________________________________________________________
Does your child have any fears that we should be aware of?
Y
N
If yes please explain. ________________________________________________________
_________________________________________________________________________
I, ______________________, hereby give Campapalooza and its staff permission to seek
medical treatment for my child, ________________, in case of emergency. I will not hold
Campapalooza or its staff liable for any injury, death, or costs pertaining, during participation of
this program. I give my child permission to participate in all activities held during the camp.
Parent's Signature________________________________ Date______________________
Parents from time to time we will take photographs of the children participating in the activities
during the program to use for advertising purposes only. Please complete the authorization
portion below if it is okay for us to use these photographs of your child for brochures, displays,
and flyers.
I, ___________________________, hereby give Campapalooza permission to use any
photographs taken of my child, ____________________________, during the program for
advertising purposes only.
Parent's Signature________________________________ Date______________________
Child's Name________________________________________________________________
Registration Date______________________________________
Camp Cost
Ext. Day
$20.00
Weekly Total
Week 1 Dodge ball 6/8-12
$109.00
$_____________
Week 2 Challenge/Survival 6/15-19
$109.00
$20.00
$_____________
Week 3 Blast from the Past 6/22-26
$109.00
$20.00
$_____________
Week 4 Stars & Stripe 6/29- 7/3
$109.00
$20.00
$_____________
Week 5 Western Week 7/6-10
$109.00
$20.00
$_____________
Week 6 Talent Week 7/13-17
$109.00
$20.00
$_____________
Week 7 Talent Show Week 7/20-24
$109.00
$20.00
$_____________
Week 8 Around the World 7/27-31
$109.00
$20.00
$_____________
Week 9 Boot Camp 8/3-7
$109.00
$20.00
$_____________
Total:
+Registration Fee:
-Discounts:
$_____________
$_____________
$_____________
Total Camp Cost:
$_____________
Office Use Only
Total Price of Camp (including reg. fee) $__________________
Amount Paid $____________________
Balance $__________________
Weekly Balance $________________
Method of Initial Payment:
Cash______ Check#___________
Money Order#___
Campapalooza Policy and Procedures
(Camps are for students K and up)
Hours of Operation
Camp is from 9:00 am to 3:00pm, Monday through Friday. Extended day is
available from 7:00am to 9:00am and from 3:00pm to 6:00pm.
Late Fees
Tuition is due on Monday (exception: payments with a credit/debit card must be
received the Thursday before). If your payment is not received by Tuesday, a
$20.00 late fee will be added. Payment must be received by the end of business
Tuesday, or the student’s membership will be suspended until payment is
received.
Late Pick Up
Camp ends at 3:00pm and closes at 6:00pm. Any student not picked up at the
appointed time will be charged $1.00 per minute late fee. This is due at the time
of pick up.
Return Check Fee
There is a $25.00 return check fee. This fee and NSF payment must be made in
cash or money order.
Personal Belongings
Students will be permitted to bring special items from home to play with. Please
remind your student that they are responsible for all items brought to camp and
that Campapalooza or the staff will not be held responsible for any lost or
damaged items. Please be sure to label all items brought to camp.
Illness
It is our goal to provide a healthy environment. If a student becomes ill, the
parents will be called to take the student home. Students who exhibits the
following illnesses will be sent home immediately:
• FEVER OF 100 OR HIGHER
• VOMITTING
• DIARREHEA
• PERSISTENT COUGH
• COMPLAINTS OF ABDOMINAL PAIN
• CONJUNCTIVITIS
• UNEXPLAINED RASH OR ITCHING
All minor injuries will be given first aid. Parents will be notified in cases of serious
injuries and must come to take their student for medical attention. If parents or
the emergency contacts cannot be reached within 5 minutes, EMS will be called.
Medication
In the event medications need to be given, the following guidelines must be
followed:
• A SIGNED MEDIACTION AUTHORIZATION MUST BE COMPLETED
• PRESCRIPTION MEDICATIONS MUST HAVE THE STUDENTS NAME ON THE
CONTAINER.
• DIRECTIONS FOR DISPENSING THE MEDIACTION NEED TO BE CLEARLY
WRITTEN ON THE CONTAINER
• ALL MEDIACTIONS NEED TO BE GIVEN TO THE CAMP COUNSELOR.
Discipline
Discipline is administered on a case by case basis and is age appropriate. This can
come in the form of an exercise, written rules or time out. Students are made
aware of what, why and how to avoid reoccurrence of said circumstance.
The following is a list of rules the students will have to follow while attending the
camp. Please go over the rules with your student, complete and return the form
with your registration packet.
• NO HITTING, PUNCHING, KICKING OR PLAY FIGHTING.
• DO NOT CLIMB ON ANY EQUIPMENT.
• FOLLOW THE “15 RULES TO LIVE BY”.
• FOLLOW ALL INSTRUCTIONS GIVEN BY CAMP COUNSELORS.
Policy and Procedure
Acknowledgement
I, __________________, have read and explained the rules to
my student(s), ___________________________. I also understand
that my student(s), can be dismissed for behavior that is
destructive or harmful to others.
Campapalooza will not offer any refunds or credits for
monies paid.
I will not hold Campapalooza and/ or its staff liable for any
injury or death suffered during participation in this
program. I give my student permission to participate in all
activities that are to be held during this program.
Parent’s Signature______________________________
Date Signed ____________________________
T-Shirt Order Form
(Please complete a separate form for each child)
Student’s Name: _______________________________________________
T-Shirt Size:
Child S (6-8)
Child M (10-12)
Child L (14-16)
__________
__________
__________
Adult S
Adult M
Adult L
__________
__________
__________
June 11th- Bowling cost: $20 for 2 games. Does include food and drinks.
Please send spending money for video games or extra snacks.
June 19th- Fire Department will stop by to give us some safety tips. No Charge.
June 26th- Skating, cost $15. Will eat lunch when we arrive back at camp.
Please send spending money for drinks, snacks or video games.
July 3rd - Field Day, $5.00. Bounce house and outdoor fun! Pizza Party!
July 10th- Diamond D cost $20.00. Let's go horseback riding and go on a
hayride. Please send lunch, will have a picnic there.
July 17th- Regal Cinemas cost $15.00."How to train your dragon 2"
July 24th- Talent Show, no charge. Talent show on Friday at 12:00pm. Parents
are invited to see the Show! Party to follow, don't send lunch.
July 31st- Jacksonville Zoo cost $20.00. Please send some spending money
for drinks and snacks for the day. Please provide a bag lunch, we
will picnic after the tour.
August 6th- Water Battle, $5.00. Water balloons, water guns. Please send sun
screen, suits, towels and a dry change of clothes. No lunch need
this day.
August 8th- Adventure Landing cost $20.00. This will include a 3 pack choice
Laser Tag, Golf, etc., and tokens. Please send spending money for
your camper for extra tokens or food.
Tuesday is Swim Day! The cost is $5.00.
Please send a swimsuit, sunscreen, towels and a dry change of clothes.