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***NOTICE CORRECTION***SPECIAL COUNCIL MEETING TO APPROVE HIRING CFO IS NEXT THURSDAY 8/18 AT 5:30PM GARABRANT CENTER***DATE IN PAPER WAS INCORRECT***      
***NOTICE CORRECTION***SPECIAL COUNCIL MEETING TO APPROVE HIRING CFO IS NEXT THURSDAY 8/18 AT 5:30PM GARABRANT CENTER***DATE IN PAPER WAS INCORRECT***      

Mendham Borough Seal BOROUGH OF MENDHAM
973-543-7152 • 2 West Main Street • Mendham, NJ 07945

Camp Sign-Up

* Fields in red are required

General Information

1. I understand and accept that the 2022 Day Camp faces unique challenges, and to open safely, the Day Camp must meet CDC, NJ, local, and legal health guidelines, including ALL covid guidelines.

2. I understand and accept that all campers and staff must pass any daily health screenings to enter campgrounds.

3. I understand and accept that if a camper cannot access to campgrounds due to a failure to pass health screenings, I may be offered credits for future weeks. All attempts will be made to reschedule a camper at the next mutually available time. I understand that the Mendham Day Camp cannot issue refunds.

4. I understand and accept that after this registration is completed, the Day Camp has staffed accordingly, and that any family decision made to keep a camper home (health, vacation, weather, etc.) is the family’s prerogative and is respected, but that family decision does not entitle a refund, as it is understood that the Mendham Day Camp cannot issue refunds.

5. that I may be called to pick up my camper when the camper is showing covid symptoms and will pick up my camper as soon as possible.

6. I understand and accept that if a camper is determined to be a health risk, that camper will be quarantined until a recognized person on the Registration Form has arrived.

7. I understand and accept that certain events that require shared resources (water, arts, play equipment, etc.) may be limited during the 2022 Day Camp.

8. I understand and accept that in the event that lightning is forecast or detected within a 40-mile radius during camp hours, the Day Camp may be moved to an indoor location at the discretion of the Day Camp Director. I understand and accept that it is the parent/guardian responsibility to register for and monitor Remind.com for updates.

9. I understand and accept that Day Camp may remain open if only rain is forecast. Staff and Campers will get wet and it will be the campers' family choice to attend. I understand and accept that refunds are not available.

10. I understand and accept that the Mendham Day Camp does not provide food or drink, other than water. Bottled water will be provided.

CAMPER REGISTRATION INFORMATION

Weekly Registration

Insurance Information (In case of emergency, this information will be required at any medical facility.)

MEDICINE DISPERSMENT: We are only able to administer emergency medications, specifically: Epi-Pens, Benadryl (for anaphylactic allergies), and inhalers.  All other medications must be dispersed either at home, prior to arrival at camp, or on camp premises by a parent/guardian.

Please note that campers who require an Epi-Pen for allergies must bring 2 to camp and that ALL medications MUST be in the original prescription box with the camper's name on it, his/her physician's name, a future expiration date, and the name of the pharmacy from which you obtained the medication.

ALLERGIES/HEALTH ISSUES: Does your child have any of the following issues?  If you answer "yes", please describe below the allergy/issue and the reaction seen.  Provide a copy of any action plans to our Medical Director.

Does your child have any food allergies?:
Epi-Pen?:
If yes, to which food(s)? Describe the reaction and indicate if an Epi-Pen was ever administered in the past:
Does your child have insect sting allergies?:
Epi-Pen?:
If yes, please describe the reaction and indicate if an Epi-Pen was ever administered in the past:
Does your child have asthma?:
Inhaler?:
Does your child have latex allergies?:
If yes, please describe the reaction:
Does your child have a history of seizures?:
If yes, please describe the reaction:
Does your child have diabetes?:
If yes, please describe the reaction:

MEDICAL/PHYSICAL/EMOTIONAL CONDITIONS: Are there any physical, mental, psychological, or behavioral conditions requiring medication, treatment, or special restrictions or considerations while at camp of which we should be aware to ensure your child's fullest enjoyment of their camp experience?  Please describe, including any special accommodations necessary.  Please note that it is your responsibility to supply any necessary medical equipment that relates to a specific medical condition.

Are there any camp activities from which the camper should be exempted for health reasons?:
Do you want to be notified immediately during the camp session for minor injuries (e.g. scrape, non-allergic bee sting, bloody nose, sliver) that do not limit participation in the program?:

RELEASE OF LIABILITY & AUTHORIZATION FOR TREATMENT: I recognize and acknowledge that there are certain risks of physical injury to campers and I agree to assume the full risk of any injuries, damages or loss, regardless of severity, which my minor child/ward or I may sustain as a result of participating in any and all activities connected with or associated with Mendham Borough Day Camp.  I agree to waive and relinquish all claims my minor child/ward or I may have against Mendham Borough and its officers, agents, volunteers, and employees as a result of participation in the program.  I do hereby fully release and discharge the Mendhab Borough and its officers, agents, volunteers, and employees from any and all claims from injury, damage or loss with the activities of the program(s).  I further agree to indemnify and hold harmless and defend the Mendham Borough and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me or my minor child arising out of, connected with, or in any way associated with the activities of the program(s).  I hereby give permission to Mendham Borough Day Camp to provide first aid treatment for minor injury or illness and to provide and arrange for emergency treatment of other illnesses.  In the event of any emergency, I authorize the Mendham Borough Day Camp to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for me or my minor child/ward's immediate care and agree that I will be responsible for payment of any and all medical services rendered.  I understand that this authorization includes that transporting of my child by ambulance, if necessary, to the nearest medical treatment facility or to the hospital, if I am unable to be reached first.  I give permission to Mendham Borough Day Camp to photocopy this form to accompany camper for medical treatment and for trips off campgrounds.


Payer Information

Payment Information

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