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Summer Camp2022 Broadview Park District3031 South 25th AvenueBroadview, IL 60155708-410-0182Summer Camp ApplicationHours of Operation:Monday - Friday7:00 a.m. – 6:00 p.m.*Please Check One*Full Day - 187.90/weekFull Day - 751.60/monthlyWeekly (Full-Day)Monthly (Full-Day)
Summer Camp2022Child’s Last Name:Child’s First Name:Address:Apt/Unit: City:Zip: Home Phone:Male or Female:Age: Date of Birth:Grade: School:Comments/Special Needs (ex: Asthma, Diabetes) Please list all medications that may berequired to provide to your child(ren) during our care.Please note – We are currently working with New Star Recreation Services (NSRS). NSRS is anorganization that specializes in providing year-around therapeutic recreation opportunities forthose who have different abilities. If you are interested in learning more about this service, pleasecontact our Executive Director, Mr. Brian Dawson @ 708-343-5637 or Mr. Brandon Banks, ourChildcare Supervisor @ 708-410-0182.
Summer Camp2022Emergency Contact InformationChild’s NameAddressCity State ZipMother’s NameHome # Work #Cell#E-mailFather’s NameHome # Work #Cell# E-mailAlternative Emergency ContactName Cell#Phone# RelationshipNameCell#Phone# Relationship
Summer Camp2022Field Trip Permission SlipDear Parents/Guardians:From time-to-time students will take field trips in the Chicagoland area. We would liketo have you sign the form below to cover field trip permission for the 2022 SummerCamp. The permission slip below covers your child(ren) for the entire program.The field trips include museums, nature walks, movie theater, and others just to name afew.If you have any questions, please do not hesitate to call us at 708-410-0182Best regards,The Broadview Park ---Broadview Park District Permission Statement2022I hereby grant permission for to participate on all field tripsfor the 2022 Broadview Park District Summer Program.I hereby reject permission for to participate on all field tripsfor the 2022 Broadview Park District Summer Program.PHOTOGRAPH AND VIDEO RELEASE
Summer Camp20222022I, hereby authorize and give full consent to the(Parent/ Guardian Print Name)Broadview Park District to photography and/or videotape, and to display all photographsand/ or publish digitally, in which I (we) or my child(ren) appear(s).I agree further that the Broadview Park District and its partner and funders may use thephotographs or video images on any or all their social media sites without limitation orreservations, or compensation. Information that I provide will be held confidential, andwill be used only to confirm my permission, if needed.I have read this document and understand its contents.Parent/ Guardian Signature:Child’s Name:Home AddressCity State ZipHome Phone: Work PhoneE-mail:
Summer Camp2022The Broadview Park District insists that all participants, parents, and/or guardianscomply with the following Code of Conduct. All participants and, parents or guardiansshall: Show respect to all participants, instructors, staff, volunteers, and other parents. Follow program rules and take direction from the director, managers, supervisors,administration, and staff. Refrain from using abusive or foul language, arguing, fighting, or any other formof a harassment or intimidation via social media or any other public platform. Refrain from smoking and/or drinking alcohol beverages on the premises Follow the safety rules and other guidelines set by the director, managers,supervisors, and administration. Show respect for equipment, supplies, and facilities. Do not display gang jewelry, clothing, symbols, hand signs, etc. The BroadviewPark District is a “neutral” zone, and these displays are prohibited. Cannot bring weapons onto District property or into its programs. Cannot bring personal toys on the premises while participating in any of ourprograms. Chrome books are accepted for school purposes only. Cannot take things that do not belong to them. Report any inappropriate, disruptive, or illegal conduct to District staff.The District recognizes that not everyone will follow this Code of Conduct. To helpmake the District’s facilities and programs fun, safe, and enjoyable for everyone, we willenforce these codes. A positive approach will be used regarding discipline.Management will periodically review rules and expectations with participants duringprogram sessions. If inappropriate behavior occurs, a prompt resolution will besought specific to each individual’s situation. The District reserves the right to dismissanyone whose behavior endangers his or her own safety or the safety of others.All participants need to abide by these basic behavior standards. We encourage parentsor guardians to review and discuss the behavior standards with their childrenparticipating in our programs. Adult participants and parents in our programs are heldto the same standards. Your voluntary participation in our programs is your consent tofollow these behavior standards and consequences.
Summer Camp2022 Every participant in the program is expected to exercise respect. This includes but isnot limited to themselves, other participants, staff members, all people, and places ofbusiness. Every participant in the program is expected to be an active listener. Every participant in the program is expected to know and understand the rulesassociated with each activity and follow them. Ask the staff member if you areunaware of the rules regarding the activity. Every participant in the program is expected to cooperate with program operations. Every participant in the program is expected to communicate in an appropriatemanner. Harsh verbal words, tone of voice, foul language, sexually inappropriatebehavior, or gestures will not be tolerated. Every participant in the program is expected to express civil conduct. Horseplay,teasing, bullying of any kind, pushing, kicking, hitting, spitting, fighting, etc willnot be tolerated and may result in suspension or expulsion from the program. Participants have the right to participate in an environment where all participantscan achieve their full potential without being impeded by discrimination orharassment based on race, religion, national origin, age, sex, marital status, politicalaffiliation, veteran’s status, disability, sexual orientation, or any other statusprotected by applicable federal, state, or local nondiscrimination laws. Harassmentmay be verbal, visual, or physical contact conduct. Every participant in the program is expected to exercise an attitude that elicits goodwill toward others and program activities. Every participant in the program is expected to promote and support a safe, fun, andhealthy environment through productive participation.
Summer Camp2022Consequences: Any participant who engages in discriminatory, harassing, or otherwiseobjectionable behavior is subject to disciplinary action and removal from the program. When aparticipant’s behavior, adult, or child, is deemed inappropriate, they will be reprimanded withusing the following steps.1. If a participant displays inappropriate behavior, staff members will verballyrequest that the behavior be discontinued. If the participant is a child, and thebehavior does not stop, the staff will implement a time-out. Time-outs are givenappropriate to the child’s age, ability, and the severity of the inappropriatebehavior. If the child’s behavior reoccurs or escalates, the parents will be notifiedimmediately, and the child will be removed from the program for that day.2. If a participant’s unacceptable behavior continues a regular basis, staff membersand the participant (and their parent) will meet. A written report will be filed,stating the inappropriate behaviors already demonstrated and the expectedchanges for the next conference meeting date. It is also to be stated that onemore incident of unacceptable behavior will result in the participants’ removalfrom the program permanently, or for a specific period of time depending onthe severity of the behavior. This report is signed by the staff andparent/guardian. One copy will remain within the Recreation Department andthe participant will retain a copy.3. If, after the above procedures have not been followed, and inappropriatebehavior continues, the participant will be removed for the designated periodpreviously determined at the conference meeting. A parent will be contactedand requested to immediately remove the child from the program.**In extreme cases of unacceptable behavior that is physically threatening to otherparticipants, parent or staff, the Executive Director, Parks & Recreation Manager or DayCare/Camp Supervisor reserves the right to immediately remove a participant from aprogram. *Note: There are no refunds given for childcare payments under these circumstancesIf you have any questions or concerns, please contact the Broadview Park District at 708410-0182 or 708-343-5637.(Please retain copy for your records)
Summer Camp2022I have read and agree with the above statements.Parent/Guardian Name:Parent/Guardian Signature: Date:Child's Name:
Summer Camp 2022 _ Broadview Park District 3031 South 25th Avenue Broadview, IL 60155
