Form Center

2. Camper Name
3. Sex
   -- Select One --MaleFemale
4. Race/Ethnicity (optional)
6. Age
7. Date of Birth
   Date of Birth
8. School Currently Attending
9. Grade Next Year
11. Address1
13. Address2
15. City
16. State
17. Zip
19. Phone
20. Alternate Phone
21. Parent Email
23. Emergency Contact other than above Parent/Guardian:
24. Contact Number:
26. Authorized Adults for Child’s Pickup (no one will be permitted to pick up a child if they are not on this list):

    Also include contact numbers for Authorized adults.

28. Special Permission to Walk To/From Camp: My child, named above, has my permission to walk to and from the program without an accompanying adult. (Only participants ages 11-12 are eligible; ages 8-10 must be accompanied by an eligible sibling age 11 and up.)
    -- Select One --YesNo
29. Parent/Guardian Signature

    By typing your name above you are agreeing that this serves as your written signature.

31. Full Day Camp Runs from 9:00 am - 4:00 pm Per Session Fees: $40 (City of Savannah Residents)/ $60 (Non-City Residents)*

    1. I understand registration is not complete until full payment has been made to the camp of choice.
33. Please mark the dates you would like to enroll your child:*

    1. Session #7 July 10- July 14
    2. Session #8 July 17-July 21

    ** No day camp on Tuesday, July 4, 2023**

    ** No day camp on Monday, June 19, 2023*

34. Location*
    -- Select One --Tompkins - 2333 Ogeechee Road - 912.651.6789Windsor Forest - 414 Briarcliff Circle - 912.921.2105Liberty City Center- 1401 Mills B. Lane Blvd.- 912-652-3804Delaware Center - 1815 Lincoln Street - 912-651-6793Tremont Center- 2015 Paige StreetWW Law Center- 900 E. Bolton StreetCrusaders Center- 81 Coffee Bluff Villa Road
36. Special Notes:
38. Does your child suffer from any disorder or medical condition that may impede or interfere with his/her ability to safely participate in any physical activity, including swimming?
    -- Select One --YesNo
39. Does your child suffer from any seizure disorder?
    -- Select One --YesNo
41. Has your child experienced seizures in the past?
    -- Select One --YesNo
42. Is your child presently under the care of a physician for any disorder or medical condition of which the City should be aware to ensure his/her safe participation in physical activities?
    -- Select One --YesNo
44. Does your child take any medications or have any other special needs (including allergies)?
    -- Select One --YesNo
46. If you answered “Yes” to any of the above medical questions, please explain:

50. Summer Camp Quick Facts:

    • Priority placement is given to City of Savannah residents. Non-residents will be placed on a waiting list and contacted the week before camp about availability.

    • Registrations should be made as soon as possible. Space is limited and filled on a first-come, first-served basis.

    • Camp Registration closes at 12:00 pm on the Friday before the week of camp, if space is still available.

    • Camp Fees must be paid the Friday prior to the week of camp. Reduced Fees are available for eligible children. NO CASH is accepted. Make checks or money orders payable to: City of Savannah

    • Please review the Parents Guide for more detailed camp information at: www.savannahga.gov/reccamp

    • Applications should be returned to the summer camp location where you would like your child to attend.

    General Information:

    Parents must sign students in and out each time the student is picked up or dropped off. To avoid camp disruptions, we ask that parents refrain from entering the camp during camp hours. Please call the Center directly if you need to speak with your child.

    Drop Off: Please drop off your child no earlier than 8:00 a.m. at their designated Community Center via the drop off zone. Due to COVID19, parents must remain in the vehicle and children will be screened before entry to summer camp.

    Pick Up: Camp ends at 4:00 p.m. Late fees of $0.50 per minute will be imposed for pickups after 5:00 p.m. Late fees must be paid prior to the child’s re-entry to camp. Students will ONLY be released to the individuals listed on the registration sheet.

    Disciplinary Action

    The following outlines the progressive disciplinary procedure, however the City reserves the right to immediately suspend campers from participating in camp for egregious behavior.

    First Offense - Center staff, activity leader, and participant will discuss behavior. Parent will be notified via phone or at pick-up.

    Third Offense – Parent/guardian will be notified of the third offense and participant will be suspended for a minimum of one day.

    Second Offense – Center staff, activity leader, and participant will discuss behavior. Parents will be required to meet with Camp Director before the child can return to the program.

    Fourth Offense – Depending on the nature of the incident, participant may be suspended for the remainder of the Summer Program. No refunds will be given.

    Waivers & Releases

    Indemnification/Hold Harmless Agreement: I/we, the undersigned, consent for me, my/our minor child/ ward to participate in the programs sponsored by the City of Savannah. In consideration of me, my/our child’s/ward’s participation in the program, I/we hereby agree to assume all the risks and hazards incidental to said participations and do further agree to waive all claims against and release, absolve, indemnify and otherwise hold harmless the City of Savannah, its employees, administrators, agents and assigns and others who assist the above, for any loss, damages or personal injuries that I, said child/ ward may receive as a result of such participation.

    Photo/Video Release: I hereby grant permission for the City of Savannah to use my and my child’s likeness/image in photographs and videos for purposes of documentation and use in newsletters, brochures, publications, webspace and other media; and understand and agree I will make no monetary or other claim against the City of Savannah for the use of these images.

    Medical Conditions/Medical Release: I/We understand the City of Savannah does NOT administer medications. I/We understand it is my/our responsibility to make the City of Savannah aware of any known personal medical condition(s) of my/our child and attest to providing this information in the space provided below. I/We understand that there are some risks inherent in the activities that are included in the Program, but willingly assume these risks in order to allow my/our child/ward to participate, and I/we give permission for Camp Staff to provide CPR and First Aid and/or emergency medical care or treatment to be provided by an emergency medical technician (ambulance EMT), physician, surgeon, nurse, doctor’s assistant, or medical care facility that may be required. NOTE: If your child has anaphylactic allergic reactions, we request that she/he bring an EpiPen or AnaKit.

    
    

52. I/WE HAVE READ, FULLY UNDERSTAND AND AGREE TO ALL OF THE ABOVE PROGRAM TERMS AND INFORMATION.

54. Parent/Guardian Signature
55. Date
    Date
57. Parent/Guardian Signature

    By typing your name above you are agreeing that this acts as your written signature

58. Date
    Date
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field