staff kid registration

Camp Salvation Staff Kid Registration

Any child who is attending Camp Salvation with their guardian, not as a Camper but also too young to be staff, must complete the Registration below and the necessary Health Record information.
Before you begin, please ensure that you have the following documents completed and available to upload:
- Statement of Health*: this can be a copy of the campers most recent physical or the linked form, must be within the past 24 months and signed by a health care provider
- Immunization Records* on the required form OR the approved Exemption Certificate
- Prescription Medication Administration Form* (for prescribed medication only, note that this will need signed by a health care provider)
*These documents or applicable alternatives are required for all campers, per regulations of the CDHS Child Care Licensing Department.

These documents are also avaliable on our website, if the above links are not working. Registrations must be complete to be accepted. All paperwork must be attached in order to submit this registration. You can save your progress at anytime. Any registration missing documentation will be considered incomplete.

Because we operate with a volunteer staff, we are only able to accommodate special meals for dietary restrictions and allergies. Our space is limited and we ask that you do not bring food to camp unless it is a medical necessity. Please contact registration staff to be sure that we have the information we need to provide meals for you or your camper.
Staff Kid Information
First Name*
Middle Name*
Last Name*
Likes to be called
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Address*
City*
State*
Zip*
Home Phone*

Area CodePhone Number
Adult attending Camp with:*
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
In addition to those already listed, two more contacts are required by the CDHS, Child Care Licensing.
Emergency Contact 1 Name (if parent or guardian is not available)*
Contact 1 Number*

Area CodePhone Number
Contact 1 Alternate Number

Area CodePhone Number
Emergency Contact 2 Name (if parent or guardian is not available)*
Contact 2 Number*

Area CodePhone Number
Contact 2 Alternate Number

Area CodePhone Number
Email Confirmation
Parents Email (confirmation will be sent by email)*
Health Information

A camp nurse is on site at all times.
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If any of the information below has changed on the day of registration please inform the nurse during check-in. If the child will be staying in a cabin with campers, all medication must be turned in to the Camp nurse at check-in. Please bring all medication or vitamins in the ORGIANAL CONTAINER or they cannot be left with the Camp medical personnel. All prescriptions must be in that child's name and the correct dosage.
For the required fields below, if nothing applies, please put "NONE" in the box.
Is child free from infectious diseases or conditions?*

YesNo
Are immunizations up to date?*

YesNo
Date of last tetanus shot*
Type unknown if not sure
Please list any known allergies and a description of their reactions: *
Please describe any physical or mental condition requiring camps special attention: *
Please list and describe any past illnesses, surgeries, accidents, or chronic health problems:*
Any activity the child should be restricted from?*
Feel free to include any other helpful information:
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except approved rescue inhalers or epipens, bring all medication in original containers. Please attach the required documentation: *
In order for the Camp Nurse or first aid responder to administer medications they deem appropriate (and only according to the directions) please check any of these over the counter meds you would approve of:*

Acetaminophen (Tylenol)Ibuprofen (Advil, Motrin)Antibiotic OintmentTumsMayloxMylantaBenadrylAfrin Nasal SpraySunscreenNone
Child's Current weight (for medication dosage purposes if needed)*
Multiple documents can be uploaded for each section if needed. If you do not have a digital copy of a document, you can take a picture and upload that version. Supported File Types include: pdf, doc, dox, png, and jpeg.
- Statment of Health
- Prescription Medication Administration (for prescribed medicaton only)
- Immunization Record* OR Nonmedical Immunization Exemption
*This record may be available from your healthcare provided but it must be in this format.

Each of these requirements must be met for anyone staying at Camp Salvation, per regulations of the CDHS Childcare Licensing Department.

Registrations must be complete to be accepted. All paperwork must be attached in order to submit this registration. Any registration missing documentation will be considered incomplete.
Please upload a copy of the most recent physical, must be within the last 24 months. *

Browse Files

Cancelof
Please upload the Prescription Medication Administration form.*

Browse Files

Cancelof
Please upload the immunization record or exemption certificate.*

Browse Files

Cancelof
Week Selection
Select which week(s) the child will be attending:*

Elementary Week (June 17-21)High School Week 1 (June 24-29)High School Week 2 (July 8-13)Junior High Week 1 (July 15-19)Junior High Week 2 (July 22-26)
Release
Release (List anyone, including parents, to whom your child CAN be released)*
Parent Permission: I realize there are inherent risks involved in participating in Camp activities. In case of emergency I understand that every effort to contact me will be made. If I cannot be reached, I give my permission to the physician selected by an authorized staff member to hospitalize and give proper treatment to my child if necessary for the safety and well being of my child and other people at Camp Salvation.

I acknowledge
- that I or my spouse are responsible for my child at all times.
- that I will review Camp Salvation's expectations and policies with my child before arrival at camp.
- that failure to comply with these terms might result in a refusal of admission.
- that my child can be dismissed for being a safety concern, disruption, or for conducting themselves in a detrimental manner.
I give my permission for my camper to*

To participate in all Camp activities except those previously mentionedTo allow Camp Salvation to use any pictures my child is in for promotional use.To be transported by staff for supervised off-site activities in staff/Camp vehicles.
By completing the following, I agree that I am are the parent or legal guardian of the above named child, and are over the age of 18. I understand that the above named child will only be released to the names listed above (an update may be completed at registration).
Electronic signature:*
Please verify that you are human*
Should be Empty:

Camp Salvation Staff Kid Registration

Staff Kid Information

Parent or Legal Guardian Information

Email Confirmation

Health Information

Week Selection

Release