2023 Camper Wellbeing Paperwork Packet Parents: please complete this form within 1-2 weeks of registering your child for a summer camp (and prior to the first day of camp). We may contact you for additional information. This form takes about 15 minutes to complete. Step 1 of 4 25% Camper InformationCamper Name(Required) First Last Camper Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Camper Age(Required)Grade Entering in Fall 2023(Required) Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Registered CampsCamps for your child that you have already registered and paid for. Select all that apply. 6/19 - 6/23 | Outdoor Adventure | North Park | Rising 3rd - 5th Grade 6/19 - 6/23 | Outdoor Adventure | North Park | Rising 6th - 8th Grade 7/10 - 7/14 | Outdoor Adventure | North Park | Rising 3rd - 5th Grade 7/10 - 7/14 | Summer on the Water | North Park | Rising 9th - 12th Grade 7/24 - 7/28 | Outdoor Adventure | North Park | Rising 3rd - 5th Grade 7/24 - 7/28 | Hooked on Fishing | North Park | Rising 6th - 8th Grade 8/7 - 8/11 | Summer on the Water | North Park | Rising 6th - 8th Grade 8/7 - 8/11 | Outdoor Adventure | North Park | Rising 3rd -5th Grade 7/17 - 7/21 | Outdoor Adventure | South Park | Rising 3rd - 5th Grade 7/17 - 7/21 | Junior Explorers | South Park | Rising Kinder - 2nd Grade 8/14 - 8/18 | Outdoor Adventure | South Park | Rising 3rd - 5th Grade 8/14 - 8/18 | Cycling through Summer | South Park | Rising 6th - 8th Grade 6/26 - 6/30 | Outdoor Adventure | Millvale | Rising 3rd - 5th Grade 6/26 - 6/30 | Cycling through Summer | Millvale | Rising 6th - 8th Grade 7/31 - 8/4 | Outdoor Adventure | Millvale | Rising 6th - 8th Grade 7/31 - 8/4 | Cycling through Summer | Millvale | Rising 3rd - 5th Grade Parent/Guardian Name(Required) First Last Parent/Guardian Phone Number(Required)Parent/Guardian Email(Required) Emergency ContactsFill in emergency contact information - can be a parent/guardian, relative, family friend, etc. You CAN include the same parent that you previously listed above in the emergency contact list if applicable.Emergency Contact #1 - Name(Required) First Last Emergency Contact #1 - Relationship to Child(Required) Emergency Contact #1 - Phone Number(Required)Emergency Contact #2 - Name(Required) First Last Emergency Contact #2 - Relationship to Child(Required) Emergency Contact #2 - Phone Number(Required)Emergency Contact #3 - Name(Required) First Last Emergency Contact #3 - Relationship to Child(Required) Emergency Contact #3 - Phone Number(Required) Camper Medical and Wellbeing HistoryMedical Conditions(Required)Complete the following chart by selecting Yes/No. Please comment on any "Yes" answers below.YesNoAsthma or other respiratory problemsGastrointestinal disturbancesDiabetesHigh blood pressureBleeding or blood abnormalitiesNeurological problems or epilepsyDizziness or fainting episodesMigrainesHeart problemsDisorders of urinary or reproductive tractKnee, hip or ankle injuries and/or surgeriesShoulder, arm, or back injuries and/or surgeriesHead injuryChild greatly affected by heatChild gets cold easilyStrokeUse this space to expand on any "Yes" responses above.Other Medical/Health Consideration(Required)Complete the following chart by selecting Yes/No. Please comment on any "Yes" answers below.YesNoAny other allergies, such as food, medication or seasonal?Will child carry medication for allergies?Does child have special dietary needs, such as vegan/vegetarian?Does child have muscle spasms?Is child taking medication? If Yes, explain below.Use this space to expand on any "Yes" responses above.Include information on side effects of any medication, if they will need to take it during program hours, etc.Child Wellbeing(Required)Complete the following chart by selecting Yes/No. Please comment on any "Yes" answer below.YesNoDoes your child have a mobility impairment?Is your child sensitive to sights, sounds or other sensations?Has your child ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?Has your child ever been treated for emotional or behavioral difficulties or an eating disorder?Has your child experienced a significant life event that continues to affect the child's life?Is your child comfortable with water?Expand on any "Yes" responses above and list any medical, physical or emotional medical concerns that are not mentioned above and provide ways we can accommodate and support your child.Sunscreen/Bug Spray Permission(Required)I give permission for Venture Outdoors staff to assist my child in applying sunscreen and bug spray as needed. Yes No Is there anything else you would like us to know about your child's wellbeing or that you would like staff to know about working with your child?Acknowledgment(Required) By selecting this box, I hereby acknowledge that the above information is true and accurate to the best of my knowledge.Today's Date(Required) Month Day Year Signature(Required) Camper Release InformationThe pick up window for camps is between 3:30-4PM daily. A late fee of $1/minute/child will be charged for late pick ups beginning at 4:01PM.Release List(Required)List out up to five individuals who may pick up the camper at the conclusion of each day. Please include yourself (if you'll be picking them up). Note: any individual picking up the camper will be asked to show photo ID.NamePhone #Relationship to Camper Add Remove Camper ContractAt Venture Outdoors, we strive to create meaningful and healthful experiences for children in the outdoors. In order to do so, we foster an environment where safety and wellbeing are of utmost importance. Please review and discuss the following guidelines with your child prior to the program. We will review this contract during the program and have students sign their understanding and agreement.Behavior Guidelines(Required) We understand and agree to the Behavior Guidelines.I will treat myself, others, and equipment with respect. I will speak highly of my fellow peers and Venture Outdoors staff. I will keep my hands to myself. I will set a positive example for others because I am a role model. I will always remain with my group and Venture Outdoors staff at all times. I will ask Venture Outdoors staff for their permission to use the restroom, get a drink of water, or go elsewhere. I agree to accept the instructions that are given to me by Venture Outdoors staff and follow them the first time.Conduct Violation(Required) We understand and agree to the Conduct Violation Code.If I act in such a way that does not follow the behavior guidelines, I understand that there may be consequences for my actions, including verbal warnings, parental contact, or suspension/dismissal from the program. My parent may need to come pick me up from the program in the event that I need to be sent home in the middle of a program. I will seek to understand why I acted the way I did and work with Venture Outdoors staff to make better behavior choices. Behavior Response Guidelines(Required) We have reviewed and understand the behavior responses guidelines. We understand no refunds will be issued in the event of suspension or termination from the program.We want to make summer camp a fun and enjoyable space for all children and staff. We expect campers to treat themselves, fellow campers and staff, and equipment with respect and care. Below outlines our team's behavior response actions. While every situation is different, these are the guidelines we follow and will work with the child and parent on a case-by-case basis. No refunds will be issued for camper suspensions or terminations. Level 1 Behaviors Level 1 behaviors warrant the following responses in order if unresolved: 1. Verbal warning 2. Parent communication 3. Parent/child meeting with staff 4. Suspension (1-day) 5. Termination Behaviors: • Misuse of food or equipment • Littering • Excessive touching/personal space violation • Not following directions • Teasing (name calling, isolation) • Profanity • Lying/dishonesty • Disrespecting staff or others • Disregarding cell phone/electronics policy Level 2 Behaviors Level 2 behaviors warrant the following responses in order if unresolved: 1. Parent communication and suspension (1 day) 2. Termination Behaviors: • Physical aggression (hurting self, shoving/slapping, kicking furniture or equipment) • Verbal aggression (yelling/screaming) • Bullying (repeated verbal, physical targeted behavior) • Out of bounds (leaving the group/property) • Stealing Level 3 Behaviors Level 3 behaviors results in immediate parent contact and termination from camp. Behaviors: • Threats • Fighting • Vandalism/destruction of property • Having drugs, alcohol, knife, gun or other weaponParent Signature(Required) We agree to the Behavior Guidelines and Conduct Violation Policy.As a parent, I have read and understand this conduct contract. I have discussed these expectations with my child, who has agreed to follow them while in the program. I understand that I will not receive a refund if my child is suspended/dismissed from the program for violation of this contract.Driving YouthConsent(Required) I give permission for my child to be shuttled by Venture Outdoors staff in a Venture Outdoors company vehicle.On occasion, we may shuttle campers in a company vehicle to reach locations within the park that may be too far for hiking or biking. We will notify you ahead of time when we plan on shuttling the campers. Campers are expected to follow the same behavior guidelines outlined in the camper contract.Acknowledgement & Assumption of Risk FormConsent(Required) I will complete an Acknowledgment & Assumption for Risk for my child.In addition to this paperwork packet, you must complete a Venture Outdoors Acknowledgement & Assumption of Risk Form for your child. Venture Outdoors staff will send this form to you to complete via a digital link.