Individual Registration

Please enter information in the form below to process registration for event 2018 Summer Day Camp.

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Authorized Pick Up

Person(s), other than parents, authorized to pick up your camper or be notified in an emergency: THE STAFF WILL NOT ALLOW YOUR CAMPER TO LEAVE WITH ANYONE WHO IS NOT LISTED ON THIS FORM.

Participant Release:

I wish to have my child attend the 2016 Jay County Boys and Girls Club Summer Day Camp. I understand that the registration fee and weekly fees are non-refundable and the weekly fees are due the Thursday before the upcoming week by 8 PM. A $15 late fee in addition to the weekly fee will be charged for all late scheduling. I hereby give my consent for the Jay Community Center to use my photograph and likeness to be used in its publications, including its website and social media. I release them from any expectation of confidentiality for the undersigned minor(s) children and myself and attest that I am the parent or legal guardian of the children listed above. My child may participate in Day/Field Trips with the Day Camp program. I understand that he/she will be traveling by bus, van and/or car. I agree to hold harmless and release the Jay Community Center and Jay County High Schools, directors, sponsors, and officials from any and all liability related to the 2016 Summer Day Camp.

Medical Emergency Release:

In the event reasonable attempts to contact parents or guardians have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by any licensed Physician, and the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery, unless the medical opinion of two licensed physicians, concurring in the necessity for such surgery, is obtained prior to the performance of such surgery.

Camper Dress Code & Sunscreen Application:

I give my permission for the Jay County Boys and Girls Club Summer Day Camp staff to apply sunscreen to my child and understand that the first application of sunscreen is my responsibility prior to sending my child/children to camp. It is also my responsibility to make sure my child has sunscreen with them daily and appropriate clothing that will minimize exposed skin during outside activities.

By signing below I agree to the Participant Release, Medical Emergency, and Camper Dress Code & Sunscreen Application

Health Problems & Medication: please attach a copy of your insurance card
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