CAMPUS DAY CAMP 2019
2901 Campus Road, Brooklyn, NY 11210 / (718) 421-7575
- Completed and signed registration form.
- If before May 31, 2019 a deposit of $500. (Full balance due on 5/31/19)
- If after May 31, 2019 full camp tuition.
- NYC DOH Medical Form filled out by a physician that includes all immunizations (PPD, MMR).
- This is based on a checkup done within one calendar year. A current form must always be on file.
- A completed Lunch Form.
- A fully completed and signed trip itinerary
1. Child’s Information
2. Parent/Guardian Information
3. Child Pick-up and Emergency Contact Information
Please list persons with phone numbers whom you give permission to pick-up your child from the program.
Please note that we will not release children to anyone not on the list without prior authorization.
Children will not be released to anyone under the age of 16.
In the event of an emergency, these people will be contacted if a parent/guardian is unavailable.
4. Camp Fees (Please Circle)
Deposit of 500.00 must be paid at time of registration.
Deposit will be applied to camp fee.
Camp must be paid for in full by no later than May 31, 2019.
Full summer is June 27-August 14. Single session is either June 27-July 19 or July 20-August 14
5. Parent/Guardian Consent
In case of an emergency injury or illness, I authorize the program to call the paramedics. As legal guardian of the above listed student, a minor, I authorize the program representative designee to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis, treatment, and/or hospital care to be rendered upon the advice of any licensed physician and/or dentist.
There will be no refund or pro-rating for absenteeism. It is our policy to charge $5.00 per quarter hour past closing time, which is 6:00 or 7:00 PM. If child is pulled out from program before end of summer no refund will be given.
Rules and regulations must be adhered to at all times.
Campus ASP Inc. reserves the right to suspend or expel a child from the program for disruptive or dangerous behavior.
Campus ASP Inc. and its employees are not responsible for personal items.
Campus ASP Inc. may at times use your child’s image on promotional items, both in print and online.
*We do not have a special needs program. Children may be accepted if they are able to be included within the group
and do not require one on one or any other additional services. We require a trial before admission of any child
with special needs.
I give consent for Campus ASP Inc. to pick up my child and attend trips using our full size school buses, mini buses, passenger vans, minivans/cars or by walking.
I give my consent for my child to attend Campus ASP Inc. and participate in its activities and trips.
I understand that my child will receive lunch and snack daily.
I have read and understand the above.
Parent/Legal Guardian Signature
Camp Office: 718-421-7575
Copyright CAMPUS Inc. – 2019 ©