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Summer Camp Registration - Panawok - 2018

Steps

  1. 1. Step One
  2. 2. Step Two
  3. 3. Step Three
  4. 4. Step Four
  • Step One

    1. Panawok Office Only.JPG

    2. Gender*

    3. Is your child fluent in English?*

    4. Does your child have an IEP or 504?*

      (if yes, please complete the information below so we can best accommodate your child. Please note: We do not reserve placement.)

    5. 2. Does your child require a smaller class size or extra assistance during the school day?

    6. An IEP or 504 information and interview (parent with child) is required before registration.

    7. CONTACT INFORMATION

    8. Parents or Guardians - Name & Contact Information

    9. Emergency Contact Person other than parent of guardian (2 names required):

    10. ARRANGEMENTS FOR DISMISSAL

    11. My child

    12. is to be dismissed from Camp in the following manner:

    13. Child is to be released to the following person(s):

    14. RELEASE OF LIABILITY

    15. In consideration of your acceptance of my child

    16. for his/her participation in the activities/programs of the City of White Plains; including permission to participate in busing, swimming, and trips. I consent to my child being videotaped/photographed for publication/broadcast/website. I agree that I am aware of the inherent dangers and risks involved in these activities/programs including bodily injury which may be the result of strenuous activity or other causes related to these activities/programs. I agree to, for my child, release and hold harmless the City of White Plains, its officials, officers, agents, employees, and volunteers, from and against any and all liability, damage or claim of any nature arising out of or in any way related to my child’s participation in these activities/programs except those things caused by the sole negligence of the City. I understand that the City of White Plains does not provide accident or medical insurance and I am financially responsible for any and all medical expense whatsoever. I am advised to consult my child’s physician before allowing my child to participate in any strenuous activity. I have read, understand, and agree with the terms of this release.