2018 Camper Enrollment

Camper Name: First & Last*

Camper Date of Birth*

Camper Gender*

Male Female

Parent #1 Name: First & Last*

Email*

Parent #1 Cell Phone*

Parent #2 Name: First & Last

Parent #2 Email

Parent #2 Cell Phone

Mailing Address Street*

Mailing Address City*

Mailing Zip Code*

Camper T-Shirt Size*

Camper Grade in Fall {after summer}*

School

Requesting a friend: To guarantee placement with your request, they must request you in return. While you may include additional requests in the "Additional Comments" field for consideration, we only guarantee one request. Camp is a great place to make new friends!

Friend Request- ONE NAME

Choosing Your Camper's Schedule

Please use the check boxes below to indicate your camper's schedule. Weeks do not need to be consecutive.

Minimum enrollments:

3 weeks, 4 days/week

4 weeks, 3 days/week

2 weeks, 5 days/week (limited spots available in July)

Select Your Camper Days*

Monday Tuesday Wednesday Thursday Friday

Select Your Camper Weeks:

Week 1: 6/18 to 6/22 Week 2: 6/25 to 6/29 Week 3: 7/2 to 7/6 {7/4 closed} Week 4: 7/9 to 7/13 Week 5: 7/16 to 7/20 Week 6: 7/23 to 7/27 Week 7: 7/30 to 8/3 Week 8: 8/6 to 8/10 Week 9: 8/13 to 8/17

Camp TransportationService*

Exact time and location released in June

Please use the box below to give us any additional information. While we will be collecting health information in the coming months, we would like to know now about any serious allergies or mental/physical challenges. You may also include information regarding your camper's schedule and/or additional campers to consider during grouping. We would also like to know if there is a camper you prefer your child NOT be placed with. If your child currently has an aide or behaviorist at school please contact our office to discuss.

Additional Considerations/Information

Terms and Conditions: Please read thoroughly and sign before submitting.

I understand and certify that my child¹s participation in Tocaloma Day Camp and its activities is completely voluntary and I have familiarized myself with the camp¹s programs, policies and activities. I recognize that certain hazards and dangers are inherent in the camp events and programs including, but not limited to the activities of swimming, rock climbing, sailing, rock climbing, yoga, tae kwon do, athletic activities, sports, archery, sea kayaking, bounce house, slip and slide and arts & crafts, and allow my child to participate in these and all camp activities knowing the dangers, risks and hazards inherent in each. I acknowledge that Tocaloma can not insure nor guarantee that the participants, equipment, premises and/or activities will be free of hazards.*

Yes, I Agree.

If Tocaloma, in its judgment believes my child requires medical attention, Tocaloma has my authorization to obtain such medical care from a licensed hospital or physician as Tocaloma deems necessary. I shall be responsible for all physicians, hospital, and related costs so incurred.

Yes, I Agree.

Tocaloma may use my child¹s photograph / likeness in promotional materials, website and social media channels.

Yes, I Agree.

On behalf of my child(ren) I voluntarily assume all risks of injury, loss, or damage that may be sustained and release and discharge Tocaloma Day Camp, its employees, officers, agents and staff from all loss or damage and from any claim or demand on account of injury or death. I agree to hold harmless, indemnify and defend Tocaloma Day Camp, its officers, staff, employees and agents for and from any and all liability, claims, expenses, demands, fees, judgments and/or damages arising directly or indirectly from my child¹s participation in camp programs or at any time my child is on the premises of or premises used by Tocaloma Day Camp, save and except claims arising out of the sole willful misconduct of Tocaloma Day Camp. I will reimburse Tocaloma Day Camp, its officers, staff, employees and agents for all expenses including reasonable attorney fees for all such claims made.*

Yes, I Agree.

I agree to pay all tuition and fees set forth on Tocaloma's 2018 Tuition Schedule found at www.tocaloma.com/tuition and this form. Tuition Payment - A $500 deposit, which will be applied to the camp tuition, is required for each camper enrolled. The balance of tuition is due and payable by March 15th 2018 for the Early Rate and May 1st 2018 for the Regular Rate. Cancellation - There are no refunds once tuition has been paid in full. The tuition will be refunded, less a $250 registration fee, when written notice of cancellation is received prior to March 15th 2018. Cancellations received after March 15th or payment in full will be subject to a cancellation charge equal to the monies received.*

Yes, I Agree.

Schedule Changes - To receive a day of credit in event of an absence, you must call or email the camp office before 7:30 A.M. We are happy to make schedule changes permitting space is available. Email requests for schedule changes that leave a balance due will be accepted and confirmed by email once payment is made. All requests must be paid in full before they are confirmed and are subject to availability. Credit toward Tocaloma week may be given for extended absence (more than five days) at the discretion of the Director. No refunds will be given. Days of credit not used in 2018 can be applied to 2019 at the rate of $100/day.*

Yes, I Agree

The Person Herein Described Has Permission To Engage In All Prescribed Camp Activities Except As Noted. Authorization For Treatment: I Hereby Give Permission To The Medical Personnel Selected By The Camp Director To Order X-Rays, Routine Tests, Treatment; To Release Any Records Necessary For Insurance Purposes; And To Provide Or Arrange Necessary Related Transportation For Me Or My Child. In The Event I Cannot Be Reached In An Emergency, I Hereby Give My Permission To The Physician Selected By The Camp*

Yes, I Agree

Withdrawal/Expulsion - No refund or reduction of tuition will be made for the withdrawal/expulsion of a camper, his/her late arrival or early departure.*

Yes, I Agree.

Health/Activities - If your child is unable to participate in any activity for any reason, please note it on his/her health history form. If your child is recovering from any health problem please notify us in writing of your wishes regarding activity and camp participation. For your child¹s safety, a Health History Form stating your child¹s ability to participate in all activities is required prior to admission.*

Yes, I Agree.

Signature of Parent or Guardian*

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Use your mouse or finger to draw your signature above

Name of Signer*

2018 Tocaloma Camper Application

Minimum enrollments:

Terms and Conditions: Please read thoroughly and sign before submitting.