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Welcome to Kids’ Country Summer Camp 2015!
We hope your child will have a memorable summer here with us! The following Summer Camp Guidelines can help make this summer enjoyable.
General Guidelines
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Our hours of operation depend upon the site and program. Traditional Camp at Bollinger, Creekside, Greenbrook, Quail Run, Sycamore,
Walt Disney, and Greenbrook - 7:00 am-6:30 pm, Specialty Camp at Coyote Creek and John Baldwin – 7:30 am-6:00 pm, Specialty Camp
at Creekside – 7:00 am- 6:30 pm, Wigalo/The Zone at Montair – 7:00 am-6:30 pm, Extreme Camp at Green Valley and Montevideo – 7:30
am-5:30 pm, Summer School Enrichment at Creekside, Greenbrook and Country Club – 12:00 pm-6:30 pm.
If someone other than you will be picking up your child, please send a written note and ask that person to have identification with him or her.
Sign your child in and out on a daily basis with your full signature in ink and include the time even though we charge by the week.
LABEL, LABEL, and LABEL. Label all personal items with your child's name (first initial. last name works best).
Children are discouraged from bringing toys to camp. We cannot be responsible for lost or damaged toys. Please leave them at home.
Please provide your child with waterproof sunscreen. Label the container with his/her name.
We encourage all children to bring a swimsuit and towel daily.
Field Trips
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Please refer to the Summer Camp Brochure for programs and sites with available field trips. Not all sites or programs will take off-site field trips.
Be sure to fill out the attached permission slip completely. Each child MUST have a signed permission slip on file to attend any field trips.
Camp T-shirt must be worn on all field trips (not on swim days).
Field Trip lunches should be placed in disposable plastic bags. Drinks should be in disposable containers (NO GLASS BOTTLES or CANS).
Please limit your child's spending money to the amount recommended by the Site Director. Your child should carry a small backpack or wallet in
which to safely carry his/her money.
Lunches
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Please send your children with a nutritious lunch daily. Please send fruit juice or water, no carbonated drinks are allowed.
We will provide lunch on some of our field trips, please refer to the calendar at your camp location.
We do not have the storage capacity to put lunches in the refrigerator or to microwave food items.
Please check with your Summer Camp Director regarding food allergies-some of our locations are nut-free.
Just remember to have fun!!
Summer Camp 2015
NAME OF CHILD:
AGE:
ENROLLED AT KIDS’ COUNTRY?: Y / N IF YES – SITE:
T-SHIRT SIZE: (please circle one) YOUTH SMALL
ADULT SMALL
GENDER: M / F
2015-2016 GRADE:
Student ID#:
YOUTH MEDIUM
ADULT MEDIUM
_
YOUTH LARGE
ADULT LARGE
Please carefully review the 2015 Kids’ Country Summer Camp brochure for age level and programming descriptions, check which camp(s) and which
week(s) you would like your child to attend. PLEASE BE SURE TO SIGN THE CONTRACT ON THE BACK OF THIS FORM.
Camp Choices
Ages
Wk 1: July 6-10
Bollinger
Creekside
Greenbrook
Quail Run
Sycamore
Walt Disney
Greenbrook
Wk 2: July 13-17
Bollinger
Creekside
Greenbrook
Quail Run
Sycamore
Walt Disney
Greenbrook
Wk 3: July 20-24
Bollinger
Creekside
Quail Run
Sycamore
Walt Disney
Wk 4: July 27-31
Bollinger
Creekside
Quail Run
Sycamore
Walt Disney
Wk 5: Aug 3-7
Wk 6: Aug 10-14
Bollinger
Creekside
Quail Run
Sycamore
Walt Disney
Bollinger
Creekside
Quail Run
Sycamore
Walt Disney
Traditional Camp
7 am-6:30 pm
5-12
years
Specialt
y Camp
7 am- 6:30 pm
5-12
years
Specialt
y Camp
7:30 am-6 pm
7-12
years
Coyote Creek
Musical Theater
Into the Woods
6-12
years
John Baldwin
Sports: Soccer
4*-12
years
Montair
Montair
Montair
Montair
Montair
Montair
Extreme Camp
7:30 am-5:30 pm
8-12
years
Green Valley
Montevideo
Green Valley
Montevideo
Green Valley
Montevideo
Green Valley
Montevideo
Green Valley
Montevideo
Green Valley
Montevideo
Summer School
Enrichment
12 pm-6:30 pm
5-12
years
Country Club
Country Club
Creekside
Greenbrook
Specialt
y Camp
7:30 am-6 pm
Wigalo/
The Zone
7 am-6:30 pm
Creekside
Greenbrook
Creekside
Animated FilmsSuper Heroes
Creekside
STEM- Circuits, Lights, Wires,
Oh My!
Coyote Creek
Master of Invention
Diving into Da Vinci
Coyote Creek
Filmmakers Academy
Mockumentaries
Coyote Creek
Filmmakers Academy
Choose your own Adventure
Coyote Creek
Musical Production
and Dj'ing
_Coyote Creek
Musical Theater
Annie Jr.
John Baldwin
Sports: Flag Football or
Cheerleading (circle one)
John Baldwin
Team Building &
Outdoor Sports
John Baldwin
Art & Photography
Cityscapes
John Baldwin
Animated Films
Super Heroes
John Baldwin
Glow Art in the Dark
Sea Creatures
*4 year olds must be registered for TK to attend Wigalow Summer Camp
Please Continue on the Back
SUMMER CAMP FEES:
 All Summer Camps are $290 per week/$275 with sibling discount.
 Summer Enrichment Camp fees $235 per week/$220 with sibling discount
 Camp fees must be paid in full prior to the start of the month.
 Cancellation fee is $100 for each week, if weekly services are cancelled after invoices are issued.
 Late payment fee is $25.
 There is a change fee of $25 for requesting a change from a selected week to a different week after invoices are issued.
 Change requests can only be honored on a space available basis.
 Late pick up fee is $5 per minute. (Note: Camp hours and closing times vary per location.)
PHOTO/VIDEO RELEASE:
I understand that my child may be photographed (still/video) while participating in activities at Kids’ Country Summer Camp. Photographs and/or video will be
used for the sole purpose of promoting Kids’ Country programs. These photographs and/or videos may be used for site albums, program brochures, media
productions, advertisements, news articles or publications to our website (www.kidscountry.org) or social media outlets. Photographs will not be accompanied by
the last name of any child. Photographs and/or videos will be taken during regular summer camp activities such as field trips, outdoor activities and free choice
times.
My signature indicates that I knowingly will not seek any form of compensation or remuneration from Kids’ Country, or its agents, for the use of my child’s
presence in a photograph and/or video.
I have read the above contract and agree to abide by its terms.
PARENT/GUARDIAN SIGNATURE:
DATE:
PRINT PARENT/GUARDIAN FIRST/LAST NAME:
SITE DIRECTOR SIGNATURE:
DATE:
Kids’ Country Summer Camp Emergency Form
Name of Camper:
Last Name
Camp Site:
Camper’s Birth Date:
Address:
City:
Home Phone:
Parent/Guardian Name:
Cell Phone:
E-Mail:
Emergency Contact:
Name:
Relationship:
Additional Authorized Persons to Pick-Up:
Name:
Relationship:
Name:
Relationship:
Health Information:
Name of Doctor:
Med. Rec. #:
Name of Dentist:
First Name
Zip Code:
Work Phone:
Phone:
Phone:
Phone:
Phone:
Phone:
Please note any health conditions that Kids’ Country Summer Camp needs to know about (allergies, medications, etc.)
In case of an accident or illness the San Ramon Valley School Age Childcare Alliance, Inc., dba Kids’ Country, has my authority to secure any
emergency medical and/or dental attention deemed necessary. My child is physically able to participate in camp activities.
Parent Signature:
Date:
Kids’ Country Summer Camp 2015
ACTIVITIES PERMISSION SLIP
I do hereby give my permission for my child to participate in the Kids' Country Summer Camp activities, field trips and swimming trips. I understand
they will be transported by First Student bus services, commercial bus or by Kids' Country vans. I give my permission for any emergency medical or
dental treatment necessary by a licensed physician or dentist.
The undersigned, in consideration of participation in this field trip, agrees to indemnify and hold the San Ramon Valley School-Age Childcare
Alliance, Inc. (SRVSACA), dba Kids’ Country, harmless and release the SRVSACA, it’s officers, employees and agents from any and all liability for
any injury arising out of, or in any way connected with, participation in these field trips.
I HAVE READ THE ABOVE AGREEMENT AND FULLY UNDERSTAND THAT MY SIGNATURE ON THIS FORM AFFIRMS THAT I
ASSUME RISK FOR ANY INJURIES MY CHILD MAY INCUR.
NAME OF CHILD:
NAME OF PARENT/GUARDIAN:
PARENT/GUARDIAN SIGNATURE:
HOME PH:
DOCTOR’S NAME:
DATE:
WORK PH:
CELL:
PH:
MED. REC. #:
DENTIST NAME:
PH: