enrollment forms
Transcription
enrollment forms
Camper’s Full Name: _______________________________ ENROLLMENT FORMS Welcome! We're happy you chose SuperCamp as part of your 2013 summer experience! We encourage you to make us a full partner in achieving your child’s successful SuperCamp experience by providing all relevant information. SuperCamp is an academic and life skills program and includes candid discussions about students’ personal experiences. SuperCamp does not provide therapy and is not appropriate for students needing support for emotional or behavioral issues. Please note that applications for enrollment can be declined and/or students dismissed from SuperCamp based on our responsibility to maintain a positive camp environment for all participants. We are excited about getting to know your child and participating in his/her growth and learning. Thank you for your thoughtful contribution to this end. Following is a list of all the enrollment forms. Please return all forms fully completed to our Oceanside office by the date specified in the cover letter. Please be sure to read the above section before completing the following required forms. You may keep this sheet for your records. REQUIRED FORMS: them off below. 1. Confidential Student Profile (three pages) 2. Agreements Parent signature Student signature 3. Physicians Health Report (completed by family physician) 4. Travel Itinerary Copy of Airline itinerary 5. Medical Release Release Signature Arrival Info Departure info Medical Insurance Student Photo 6. Key/Damage Deposit (signature and deposit) ADDITIONAL FORMS (optional): 7. SuperCamp Product Order Form 8. Learning Forum SuperCamp Scholarship Donation Form Also find an enclosed General Information, Suggested Packing List, Dormitory Information and details related to Communication during camp. These pages are for your information do not need to be returned. QLN/SuperCamp 1938 Avenida del Oro, Oceanside, CA 92056 Phone: 800-285-3276 760-722-0072 Fax: 760-305-7770 E-mail: enrollments@supercamp.com www.QLN.com Confidential Student Profile HOUSEHOLD INFORMATION HEALTH HISTORY Student’s legal name: _____________________________________ Describe your child’s past and current health: _________________ Student’s email address: __________________________________ _______________________________________________________ Student cell phone: ( _______________________________________________________ ) ________________________________ Student date of birth: _____________________________________ Mom’s cell phone: ( ) __________________________________ Mom’s employer: ________________________________________ Mom’s position: _________________________________________ Dad’s cell phone: ( )___________________________________ Please check all of the following that apply to your child: Allergies: Asthma General Food Bee Stings Other* Diabetes Epilepsy Other chronic illness * Record medication allergies under “Medication Information” on next page. Dad’s employer: _________________________________________ Please explain any selected above: __________________________ Dad’s position: __________________________________________ _______________________________________________________ Primary family email address: ______________________________ _______________________________________________________ Will you be traveling while your child is at camp? Yes No If yes, please provide the following info: Has your child seen a counselor, psychotherapist or psychiatrist in the last five years? Yes No Travel dates: ___________________________________________ If yes, please state the reason for counseling as well as when and how long your child took part in counseling. Destination: ____________________________________________ __________________________________________________ Telephone: ( __________________________________________________ ) _______________________________________ EMERGENCY CONTACTS (other than yourself) Name: _________________________________________________ __________________________________________________ Relationship: ___________________________________________ What essential and pertinent health information should the SuperCamp Wellness Person know about your child? Day telephone: ( __________________________________________________ ) ___________________________________ Evening telephone: ( )________________________________ Name: _________________________________________________ __________________________________________________ __________________________________________________ Relationship: ___________________________________________ Day telephone: ( ) ___________________________________ Evening telephone: ( ) ________________________________ Married Divorced Single Separated Other If divorced/separated, who has custody of child? Mother Father Joint If joint, do both parents agree to child attending SuperCamp? Yes No If no, does enrolling parent have the right, without the consent of the other parent, to send the child to SuperCamp? Yes No Recent death, divorce, or other stressful situation in the family? Yes No If yes, please explain: _________________________________________ ___________________________________________________________ Does your child know that he/she is going to SuperCamp? Yes Do you have a primary physician? Yes No If yes, please provide the following: BACKGROUND INFORMATION Parents are: PHYSICIAN INFORMATION No If no, please explain why and indicate when child will be informed. __________________________________________________ Physician/Practice name: __________________________________ Physician telephone: ( ) _________________________ PHYSICAL EXAMINATION SuperCamp requires a physical examination within the 12 months prior to the start of camp. All immunizations must be up to date. (Please see Physician’s Health Report form.) Date of last physical exam: ______________________________________ Date of scheduled appointment: _________________________________ Full participation in camp activities? Yes No If no, please explain: ___________________________________________ ____________________________________________________________ ____________________________________________________________ Confidential Student Profile (page 2) MEDICATION INFORMATION Is your child allergic to any medication? BEHAVIOR Yes No Please specify:_______________________________________ Medication needed while at camp? Yes No To give your child the best opportunity to succeed, all medications currently used during the school year for attention and/or hyperactivity should also be used at SuperCamp. All medication must be checked in at registration (with the exception of inhalers, EpiPens, and birth control pills) and must be in original prescription containers that include patient name and dosage information. Medication: ______________________________________________ Purpose: _________________________________________________ Dosage: __________________________________________________ Because SuperCamp does not provide therapy and is not appropriate for students needing support for emotional or behavioral issues, we would like you to answer the following questions. If you answer yes to any of the following questions, please explain fully. Has your child an expressed interest in leadership programs? No Yes Explain: _________________________________________________ ________________________________________________________ ________________________________________________________ Is your child involved with any extra-curricular activities at school or in your community? No Yes Medication: ______________________________________________ Explain: __________________________________________________ Purpose: _________________________________________________ ________________________________________________________ Dosage: __________________________________________________ ________________________________________________________ Medication: ______________________________________________ Purpose: _________________________________________________ Dosage: _______________________________________________ Has your child been involved with administration services for disciplinary actions in the last 12 months? No Yes Explain: __________________________________________________ ________________________________________________________ SOCIAL SKILLS Does your child work well in a cooperative group setting? Yes No Don’t Know Does your child socialize with a group of friends? Yes No Don’t Know Does your child avoid inappropriate risky behaviors? Yes No Don’t Know ________________________________________________________ Has your child been expelled or suspended for any reason in the past 12 months? No Yes–Suspended Yes–Expelled Explain: __________________________________________________ ________________________________________________________ ________________________________________________________ Additional Comments: ______________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ REASONS FOR SUPERCAMP What are your top three reasons for sending your child to SuperCamp? Study skills/Improved grades Organization Self-esteem/Confidence Social/Communication Future academic preparedness Fun Motivation Goal-setting Other _______________________________________________ _______________________________________________________ Has your child ever exhibited any violent behavior towards others? No Yes Explain:_________________________________________________ ________________________________________________________ Has your child exhibited any self-harm behaviors in the last 12 months? (i.e. cutting, eating disorder, suicide attempt) No Yes Explain: __________________________________________________ ________________________________________________________ Confidential Student Profile (Page 3) LEARNING CAPABILITIES Current GPA: _________________________________________________ In which of these areas does your child show interest and/or aptitude? Art / Graphic Design Organization skills Writing / Reading Dance / Athletics Leadership Mathematics ____________________________________________________________ Music Other: _________________ _______________________________________________________ Community Service Does your child have an educational consultant or academic advisor? Yes No If yes, please explain: __________________________________________ Has your child participated in any of the following: Advanced Placement Honors International Baccalaureate ROTC / ROP GATE AVID What additional information can you provide about your child’s academics? _____________________________________________________ _____________________________________________________ _____________________________________________________ Has your child been diagnosed with any of the following? Attention Deficit Disorder Hyperactivity _____________________________________________________ Dyslexia Dysgraphia _____________________________________________________ Other (please be specific): SIGNATURE Does your child have trouble following directions and focusing attention? Yes No If yes, please explain: __________________________________________ ____________________________________________________________ ____________________________________________________________ REPORT CARD Please attach a copy of your child’s most recent report card. Knowledge of your child’s strengths and weaknesses in a learning environment will provide invaluable information for us. (Please attach report card copy in space provided below.) All information provided in this Confidential Student Profile (pages 1 to 3) is complete and true to the best of my knowledge. Sign and Date:_____________________________________________ Agreements TRANSFER POLICY CAMP DISMISSAL Once enrolled in a camp session, transfer to a different campus (depending on availability) is possible if requested at least two weeks (14 days) prior to the old and new camp start dates. Additional expense will not be incurred unless the new program fee is higher. In order to maintain the positive environment of the camp and protect all participants, SuperCamp reserves the right to dismiss any student who breaks any of the following agreements. If a student is dismissed, parents will be contacted to make immediate travel arrangements, and no refund will be considered. Being on Location: Students agree to stay on site in the areas designated by the staff for the duration of the camp. Respect for Other People: Students agree to respect the rights and safety of others and not exhibit inappropriate physical and/or verbal behavior. Respect for Possessions of Others: Students agree to respect the privacy and possessions of others. Respect for Campus Property: Camps are held on private property and students agree not to damage, alter, or remove anything from the campus. Parents are liable for damage caused by their child. Forbidden Items: Cigarettes, chewing tobacco, alcohol, marijuana, weapons, chemicals, animals, over-the-counter medications, prescription drugs not prescribed in the student’s name, or abuse of drugs prescribed to the student, are forbidden at SuperCamp. If a student is found in possession of or using any of these items he/she will be dismissed from camp. In cases of illegal substances or weapons, the local authorities will be contacted. If a student presently smokes, we suggest quitting at least two weeks prior to camp. Nicotine patches and/or Nicorette gum may be used at camp if coordinated through the Wellness Person with parental permission noted in the Health History section of the Confidential Student Profile form CANCELLATION POLICY Notification of withdrawal from SuperCamp must be made in writing. The following cancellation fees apply based on the date your written notice of cancellation is received in the SuperCamp Oceanside office: Cancellation Notice Received Cancellation Fee September 1 – December 31 January 1 – February 28 March 1 – March 31 April 1 – April 30 May 1 – May 31 Beginning June 1 $ 500 $ 750 $ 1,000 $ 1,250 $ 1,500 Full tuition The following additional policies apply: In the event of a physical illness or injury to the student necessitating st cancellation on or after June 1 , 50% of the cancellation fee may be applied to a U.S. SuperCamp session the following year. In order to qualify for this "rollover" we require written certification by the attending physician at the time of cancellation that the nature of the illness or injury prevents the camper from safely participating in any camp session during the current year. If a child is a "no show," no refund is possible as expenses have already been incurred. If a child has not arrived at SuperCamp by midnight on day one, he/she will be considered a "no show." EARLY DEPARTURE INSURANCE There are no refunds offered once a student arrives at camp unless you purchase the Early Departure Insurance (EDI), which protects your investment in camp tuition if your child leaves early. To qualify for EDI, you must purchase the plan at least 24 hours prior to the start of camp. You will receive 75% of the prorated tuition if your child leaves early due to illness that develops any time after arrival at camp, or for reasons of voluntary withdrawal after the first two days of camp. No refund is possible for voluntary withdrawal before day three of camp. The Early Departure Insurance premium is $95 and is not refundable. To purchase Early Departure Insurance, please call our Customer Service Department at 800-285-3276. Exclusions: No refund will be given for the following: 1. 2. 3. 4. 5. 6. 7. 8. Failure to attend camp for any reason (see "Cancellation Policy") Temporary absences Any withdrawal prior to or within the first two consecutive calendar days of the camp session (except for illness or injury) Dismissal from camp (see "Camp Dismissal") Boycotting of camp by the camper Rebellion, riot or civil commotion Destruction of any camp facility due to any cause Closures due to national or natural disasters beyond our control including widespread illness on campus DRESS CODE Students are expected to observe a mode of dress and personal grooming and hygiene that are supportive of a positive learning environment promoting self-respect. We do not allow attire that displays inappropriate slogans and images or clothing that is sexually suggestive. Any student wearing inappropriate attire will be required to change his/her clothes. LIABILITY I understand that SuperCamp will take every possible precaution to ensure the health and safety of all students. I give consent to SuperCamp staff to inspect my child’s room and/or property. I agree to indemnify and hold SuperCamp and its agents, including On The Edge Productions, harmless for any and all liability incurred as a result of my child’s participation. As consideration for my child’s participation, I agree to assume full responsibility for any personal loss, injury, illness, medical supplies, or medication. I also assume full responsibility and consideration if my child is dismissed from SuperCamp, and agree to make immediate travel arrangements, at my own expense, for my child to return home. I agree that the terms hereof shall serve as release and assumption of risks for my heirs, executors, administrators, and all members of my family, including minors. PERMISSION In order for campers to keep in touch with each other, a directory will be provided to graduates of each camp session. Directories will include student name, phone number, and email address (if available). During the program, there may be interviews, photos and video recordings taken of the students. We hereby give QLN/ SuperCamp permission (without further consideration) to include the student’s name and contact information in the camp directory and to take and use statements, photos and video recordings (if any) for future promotions. SIGNATURES I/We have read and understand and agree to all of the terms in this enrollment package. All information provided by me/us is true and complete to the best of my/our knowledge. I/We confirm agreement by signing below: _______________________________________________________ Student Signature Date _______________________________________________________ Print Student Name _______________________________________________________ KEY /DAMAGE DEPOSIT Date A $90 deposit must be submitted to offset charges that may be incurred by Parent Signature _______________________________________________________ the camper for any damage or lost keys. If damage exceeds $90, you will be Print Parent Name responsible for additional costs. Deposits will not be processed unless expense is incurred. Camper’s Full Name:__________________________ Date of Birth:________________________________ PHYSICIAN’S HEALTH REPORT (TO BE COMPLETED BY FAMILY PHYSICIAN OR NURSE PRACTITIONER) Dear Health Care Provider, The above-named child is planning to spend part of his/her summer at SuperCamp, which is a residential summer program that balances academics with life skills and daily physical activities. Please complete this form in full to comply with requirements of local, state, and other government authorities. This camp must and does comply with the American Camp Association guidelines and regulations of associated Departments of Public Health and is licensed by the local board of health. Which of the following, if any, has the child had? Physical Examination A physical examination within the 12 months prior to attending SuperCamp is required. If student does not require a full physical examination, a “wellness check” is recommended. Date of most recent physical examination: / Measles Chicken Pox Mumps Hepatitis German Measles / Please list any and all medications including prescriptions, over-the-counter medications, vitamins and/or supplements: Medication: Dosage: Purpose: Medication: Dosage: Purpose: Medication: Dosage: Purpose: Is the above-named child fit to attend SuperCamp? Yes What physical or mental health limitations does he / she have? No None Has limitations Please explain and provide all information related to child’s physical restrictions, ongoing treatments, and/or emotional or mental health about which camp staff should be aware: _________________________________________________________________________________________ _______________________________________________________________________________________________________________________ Immunizations: Please give dates of all immunizations (Attach immunization records if preferred.) Vaccine Month/Year Month/Year Month/Year Month/Year Month/Year Month/Year DTP ___________ ___________ ___________ ___________ __________ ___________ TD (tetanus/diphtheria) ___________ ___________ ___________ ___________ __________ ___________ Tetanus ___________ ___________ ___________ ___________ __________ ___________ Polio ___________ ___________ ___________ ___________ __________ ___________ MMR ___________ ___________ ___________ or Measles ___________ ___________ or Mumps ___________ ___________ or Rubella ___________ ___________ HIB ___________ ___________ ___________ Hepatitis B ___________ ___________ ___________ Chicken Pox ___________ ___________ BCG ___________ TB Mantoux test (recommended) Date of last test: ___________ Result: Positive Negative Print Physician/Nurse Practitioner’s name:___________________________________________________________________________________ Physician/Nurse Practitioner’s signature: __________________________________________________________ Date: _____________________ PLEASE FAX OR MAIL TO: SuperCamp, 1938 Avenida del Oro, Oceanside, CA 92056 Telephone: 800-285-3276 760-722-0072 Fax: 760-305-7770 E-mail: enrollments@supercamp.com Camper’s full name: ______________________________ Camp date: _____________________________________ Best number to confirm travel: ( ) ______________ Travel Itinerary This form must be received in our office in Oceanside, CA, by the date indicated in our cover letter. A completed Travel Itinerary form is required whether your child is traveling by car or plane to ensure that our staff can make appropriate arrangements for the arrival and departure of all campers. In addition to this form we require a copy of the official travel itinerary from your chosen airline. This is to ensure accuracy of flight information. PLEASE NOTE: Children traveling without a parent or legal guardian are considered to be unaccompanied minors. All airlines have restrictions regarding ages of children travelling alone and most airlines provide a service to assist these children during their airline travel. The applicable age restrictions and fees vary so it is vital that you check with airlines regarding their UM program at the time you make your child’s reservations. See “Travel Arrangements” section of General Information page for additional information. ARRIVAL INFORMATION (please check one) By Car (campus registration is between 10 a.m. and 12 noon) Arrival date ______/______/_______ Attached Original Airline Itinerary Time _________:_________ By Plane (arrivals should be scheduled between 9 a.m. and 11 a.m.) Arrival date ______/______/_______ Time _________:_________ Airline _________________________ Flight #_________________ Airline-assisted Unaccompanied Minor (see note above) DEPARTURE INFORMATION (please check one) By Car (check-out is between 12 noon and 12:30 p.m.) Attached Original Airline Itinerary Departure Date ______/______/_______ Time _________:__________ Authorized parent or guardian picking up camper: _________________ By Plane (departures should be scheduled between 3 p.m. and 5 p.m.) * Students with departing flights scheduled prior to 3PM will likely miss the graduation ceremony to ensure an on time flight departure. Departure date ______/______/_______ Time _________:_________ Airline ____________________________ Flight #_________________ Airline-assisted Unaccompanied Minor (see note above) Shuttle Service: SuperCamp provides courtesy shuttle service for the following airports. CAMP LOCATION AIRPORT CODE AIRPORT NAME Brown University PVD TF Green International Kent University CLE Cleveland Hopkins International Loyola University Chicago ORD Chicago O’Hare International Loyola Marymount University LAX Los Angeles International Stanford University SFO San Francisco International University of California, Berkeley OAK Oakland International University of California, Los Angeles LAX Los Angeles International University of South Florida TPA Tampa International University of Texas, Dallas DFW Dallas - Ft. Worth International Wake Forest University GSO Piedmont Triad International Shuttle Safety: Please instruct your child regarding the following shuttle safety procedures prior to his/her trip. 1. 2. 3. 4. Passengers should remain seated at all times with heads, hands, arms and legs inside the vehicle. Seat belts should be fastened – one person per seat belt. Noise level should not distract the driver. There should be no throwing of objects or other disruptive behavior. Passengers should enter and leave the vehicle under the direction of a staff member and/or the driver. Camper’s Full Name: ________________________________ Medical Release In the event of serious illness or injury, parents and/or emergency contacts will be called. In the event neither can be reached, I authorize SuperCamp staff to transport my child to the medical facility designated by SuperCamp for emergency treatment. I hereby give permission to medical personnel to secure and administer proper treatment, routine tests, hospitalization, x-rays, injections, surgery, and/or anesthesia and to release any records necessary for insurance purposes for my child. Minor illness or injury, as determined by SuperCamp wellness person on site, will not result in notification of parents and/or emergency contacts. I also give permission for medical personnel to administer all stated medication as well as over-the-counter medication provided by either the family or SuperCamp. I also consent to allow SuperCamp to contact the physician listed on the Student Profile form regarding any medical/psychological history and/or any medication listed. ________________________________________________________________________ ___________________________ Parent/Guardian signature Date ________________________________________________________________________ Print Parent/Guardian name Medical Insurance Photograph INSURANCE INFORMATION All students must be covered by medical or travel insurance. Please complete the information below and provide a photocopy of the relevant insurance card (front and back). Insurance company: __________________________________ Group policy number: _________________________________ Insurance company telephone: _________________________ After-hours telephone: ________________________________ Copy of Medical Insurance Card Front Copy of Medical Insurance Card Back ATTACH RECENT PHOTO HERE Please write student’s name on back of photo Camper's Full Name: __________________________________ Key / Damage Deposit A key/damage deposit of $90.00 is required for every camper. This deposit will be held as collateral to offset any charges made by the college or university for lock replacement or damage to property. We will not process your check or charge your credit card unless an expense is incurred by your child. Checks not used will be shredded. Keys: It is important to note that locks are changed by the colleges as soon as it is reported that a key has been lost in order to protect the property of the occupants and the college. Therefore, the lost-key charge is applied whether or not the key is subsequently found. This applies during SuperCamp as well as after camp so please make sure your child's room key is turned in before you leave the campus after graduation. Damage: Please note that should damages exceed the $90.00 deposit amount, you will be responsible for additional costs. Acknowledgment I hereby acknowledge my agreement with the foregoing key and damage deposit requirements. ________________________________________________ ____________________ Parent/Guardian signature Date ________________________________________________ Print Parent/Guardian name CHECK ENCLOSED (Please make payable to SuperCamp and send original check, not a copy.) Check number:__________ USE CARD ON FILE Verify last four digits________ Exp date_______ (Please sign below for authorization to use credit card) CREDIT CARD Visa MasterCard Discover American Express Card number: __________________________ Security code: ______________ Expiration date: ________________________ ZIP code: __________________ Name on card: ____________________________________________________ Signature: ________________________________________________________ SuperCamp Scholarships Donation Form Through tax-deductible donations to Learning Forum International, we’ve awarded SuperCamp scholarships to more than 700 students since 1989, giving them a brighter future. We welcome your commitment to Making Great Kids Greater! “My reading speed went from 234 words per minute to 755 words per minute! You made this life changing journey, a reality for me!” - excerpt from Tara, a 2011 winner YES! I would like to make a donation to the SuperCamp Scholarship Fund and help send kids to SuperCamp. Name: _________________________________________________________ Address: _______________________________________________________ City: ____________________________ State: _________ Zip: ___________ Home Telephone: __________________ Work Telephone: _________________ Email: ___________________________ Fax: __________________________ Amount of Tax-Deductible Donation: $20 $50 $100 $500 $1,000 $_______ (any amount is appreciated) $1,500 (half scholarship) $3,000 (full scholarship) Please note that 100% of all donations goes toward SuperCamp tuition costs. Payment Method: Check enclosed (payable to Learning Forum International) Charge my credit card: Visa MasterCard Discover Card number: ___________________________________ Name on card: ___________________ Expiration: _______ Signature: ______________________________________ Thank you! we appreciate your support in providing a brighter future for kids. Learning Forum International is a 501(c) (3) non-profit organization. Donations are tax deductible to the extent allowed by law. 1938 Avenida del Oro, Suite A, Oceanside, CA 92056 • 760-305-7317 • www.learningforum.org • www.8keys.org FAX: 760-305-7766 Important Camp Information - Please Keep ARRIVAL DAY Please ensure that arrival and departure dates coincide with the first and last day of your child’s camp. Accommodations are not available except for stated dates. If driving, please plan to arrive between 10:00 a.m. and noon on the day camp begins. If flying, the student should arrive at the designated airport between 9:00 a.m. and 11:00 a.m. on the day camp begins. Students are met in the baggage claim area by staff members carrying a SuperCamp sign and wearing a SuperCamp shirt and nametag. Lunch for students is served from 12:30 p.m. to 1:00 p.m. SuperCamp begins at 1:30 p.m. with orientation. Since special activities are planned for students the moment they check in at camp, we request that parents depart immediately following registration. DEPARTURE DAY Parents are welcome and encouraged to attend the SuperCamp graduation. A reception (coffee and tea) at 9:00 a.m. is followed by a parent meeting and then graduation, which ends at 12 noon. Students departing by car should plan to leave campus by 12:30 p.m. Flights should be arranged to depart from the designated airport between 3:00 p.m. and 5:00 p.m. Students with departing flights scheduled prior to 3 p.m. will likely miss the graduation ceremony to ensure an on time flight departure. Vans will be arranged to transport students from SuperCamp locations to designated airports for departing flights. TELEPHONE CALLS / VISITS We cannot maximize the effectiveness of the program if the student’s experience is interrupted by visits, excessive phone calls, or removal from camp. It is requested that calls to campus and departures from campus be made only for emergencies. Prior to camp you will receive the campus mailing address and telephone number. If you need to leave a message for your child, the on-site office hours are 8:00 a.m. to 8:00 p.m. (camp time zone). Students may bring a cell phone which must be checked in on arrival and can be checked out for calls on certain days for a limited time. The time of day will vary depending on the camp session. If a student fails to turn in his/her cell phone and it is found in his/her possession, the student will lose their cell phone privileges for the duration of camp. OUTDOOR ADVENTURE DAY We use professional and experienced companies to set up and safely assist students through all Outdoor Adventure events. Individual physical needs are considered. Participation in this activity is encouraged, but not required. ACADEMIC AND LIFE SKILLS CURRICULUM Course room times vary by subject. Students may be in the course rooms for six hours or more a day. The curriculum is highly interactive with breaks scheduled throughout the day. We reserve the right to alter or cancel any course advertised if such action is deemed necessary to improve the camp’s overall effectiveness. EVALUATIONS We maintain a non-competitive environment where students measure their own success based on personal progress during camp. A selfassessment form is provided to each student at the Junior and Senior Forum levels. The self-assessment form is mailed to parents by the end of September. Elective credit is given by some schools for participation in SuperCamp’s Senior Forum. Certificates are mailed in September with the self-assessments forms. IN CASE OF EMERGENCY Please provide appropriate telephone numbers in the Emergency Contacts section of the Confidential Student Profile form so that we are able to reach parents or designated emergency contacts both day and night. Please also include your child’s cell phone number (phone to be used while traveling) in the Household Information section of the Confidential Student Profile form. REQUIRED FORMS Confidential Student Profile Please be sure to answer all questions completely and provide any additional information that may enhance our ability to ensure that your child’s SuperCamp experience is positive. Agreements Both parent and student signatures are required on the Agreement form. In the event that you are unable to obtain your child’s signature prior to returning this form, please make a copy of the agreement form, have your child sign it ASAP and send it to our office in Oceanside, CA, prior to the first day of camp. Physician’s Health Report Have your child’s physician or nurse practitioner fill in all requested information, including a complete record of all immunizations. Note: All medication must be checked in with the Wellness Person at registration (including over-the-counter medications, vitamins and supplements). Inhalers, EpiPens, and birth control pills do not have to be turned in. Travel Itinerary Please complete this form whether your child is traveling by car or plane and return it to our office in Oceanside, CA, as soon as travel plans have been finalized. Should travel plans change after submitting the Travel Itinerary form, please contact our office immediately at 800-285-3276 or email us at enrollments@supercamp.com. In addition to this form, please submit a copy of your official airline itinerary to ensure accuracy of flight information. Medical Release Sign the medical release form and include a copy of your medical insurance card (front and back) or a copy of your child’s temporary travel insurance coverage. Attach a current photo of your child to this form. Key/Damage Deposit A $90 key/damage deposit is required for every camper. Please sign the form and provide us with credit card information or mail us a check (original, not copy) which will be held securely by SuperCamp. Parents will be notified of any lost key or damage report by October. If keys are returned by the last day of camp and no damage is reported, check or credit card information will be shredded. TUITION Tuition must be paid in full by May 1, 2013 unless prior arrangements have been made with our Oceanside office. If final payment is not received by this date, you could forfeit your child's place in the SuperCamp program and be subject to our cancellation fees. TRAVEL ARRANGEMENTS Traveling Alone: Campers traveling alone will be met at baggage claim by our SuperCamp staff who will be wearing SuperCamp T-shirts and carrying ID. Unaccompanied Minor: If your child is flying as an unaccompanied minor registered for assistance by an airline, an additional fee is required by the airline. Please check with your airline regarding age guidelines, restrictions, and fees. For security, the airline requires SuperCamp staff to show a photo ID and obtain a security pass in order to pick up your child in a secured area. Please see Travel Itinerary form. Baggage Fees Please check with your airline regarding baggage fees and prepay options. If possible, prepay baggage fees for your child's return trip. Otherwise, make sure your child has the cash required for baggage fees. Any baggage fees paid by SuperCamp staff will be billed to you. Airports SuperCamp provides courtesy shuttle service on arrival and departure days to and from designated airports only. Please check the airport for your child’s camp location on the Travel Itinerary form before making any flight reservations SUPPLIES All students receive a SuperCamp “playbook,” pens, and all course materials. The playbook contains valuable information useful for review after camp and during the school year. Suggested Packing List – Please Keep shorts for each day short-sleeve shirts for each day underwear for each day + extra socks for each day + extra 2 pairs of long pants 2 long-sleeve shirts sweatshirt wind jacket sneakers (dresses or skirts not recommended) sandals flip-flops for shower 2 pairs of pajamas bathrobe ear plugs (if needed for sleeping) toothpaste, shampoo, soap, deodorant, etc. cell phone and charger non-perishable snacks reusable water bottle sunglasses medication(s) (in original Rx containers) sunscreen/lip balm small fan (dorms may not be air conditioned) bug spray $30 for misc. expenses such as campus book store purchases or airport snacks $40 for return flight baggage fee PLEASE NOTE: SuperCamp is not responsible for lost or stolen personal property. We suggest all personal items be labeled. All labeled lost and found items will be mailed to the camper’s US home address following graduation. Int’l items will not be mailed. Unlabeled lost and found items will be donated to a local charity 48 hours after camp has ended. What to Leave at Home We are able to achieve our results by providing a safe, focused and engaging environment, free of distractions. For this reason, all audio/visual devices such as music players, TVs, stereos, iPads, laptops, etc., and all sports equipment, skateboards, rollerblades, scooters, etc., should be left at home. If students arrive with any of the above items, or if they are found in someone’s possession during camp, they will be taken and stored in the SuperCamp office for the duration of the program. It is the camper’s responsibility to retrieve these items from the office immediately following graduation. Please leave all valuables at home. No animals allowed. Dormitory Information Housing is in furnished college dormitories. Students are housed two to four per room depending on the campus. Bathrooms are either shared by students in two rooms or students may share a hall bathroom. Basic linens and towels are provided. Most dormitories are not air conditioned. Most course rooms are air conditioned. Team Leaders help supervise the students and are assigned to the same dormitories. Male and female students and Team Leaders are housed in separate areas of the dormitories. No laundry facilities are available. Depending on the site, temperatures can range from 70°–95° during the day and 60°–80° at night. Communication We understand that you are interested in what your child is doing. We provide photos of your child’s session that you can view online every day. To view photos, follow the instructions to the secured photo website provided in your parent letter. This important letter will be emailed to you approximately two weeks prior to your child’s camp start date and will include information regarding communication with the camp site staff. Cell phones brought to camp must be turned in during registration. Cell phones may be checked out on certain days for a limited time. The time of day will vary depending on the camp session. If a student fails to turn in his/her cell phone and it is found in his/her possession, the student will lose their cell phone privileges for the duration of camp. Although we allow students to make phone calls, we encourage them to limit their phone usage as we find that it distracts them from being fully engaged in the program. Just like you, we want your child to get the most out of his/her SuperCamp experience. Please help us by doing your part in following these guidelines and we will do our part to make your child’s camp experience as valuable as possible.