PHILANTHROPY CAMP 2019

Camper Application

Rising 1st Graders – Rising 6^th Graders

Philanthropy Camp is a one-week day camp designed to provide elementary-age children with opportunities to “give back” to others and to understand the positive differences they can make in their community. Through hands-on-activities, games, field trips, speakers, art and drama, campers will explore the concept of and the relationship between philanthropy, faith, family and community. Philanthropy Camp is a joint program of Chattanooga First Church of the Nazarene and the Jewish Federation of Greater Chattanooga.

Philanthropy Camp is a one-week day camp designed to provide elementary-age children with opportunities to “give back” to others and to understand the positive differences they can make in their community. Through hands-on-activities, games, field trips, speakers, art and drama, campers will explore the concept of and the relationship between philanthropy, faith, family and community. Philanthropy Camp is a joint program of Chattanooga First Church of the Nazarene and the Jewish Federation of Greater Chattanooga.

Contact:

Ann Treadwell
[email protected]
423-667-9657 ext. 13

Date:

July 29 – August 2, 2019

Time: 9 a.m. to 4 p.m. daily

Drop off/Pick up

Location:

Chattanooga First Church of the Nazarene
5455 North Terrace, Chattanooga, TN 37411

Camp Tuition:

$125.00 for the first child
$110.00 for each additional sibling

Payment details:

Please see the camper application form below. You may submit the application electronically using the form below or you may mail or drop off your completed forms and payment (payable to Jewish Federation) to:

Mail to:
Jewish Federation
PO Box 8947, Chattanooga, TN 37414

Drop off:
Jewish Federation
5461 North Terrace Road, Chattanooga, TN 37411

Philanthropy 2019 - Camper Application

Please submit your application upon completing the fields below.

Camper Information
Child's Full Name*

Preferred Name

Child's Age*

Birth Date*
Month
Day
Year

Male / Female*
Grade camper is entering in the fall 2019*

Address
Street Address Address Line 2 City State ZIP Code

T-Shirt Size*
Parent/Guardian 1 Information
Name*
First Last

Phone*
Email*

Address*
Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Information
Name
First Last
Phone
Email

Address
Street Address Address Line 2 City State ZIP Code

Additional Emergency Contact
If parents cannot be reached
Name
First Last
Relation to child

Phone
Email

Please list other adults to whom your child may be released or who may provide transporation

Is there anyone who may not pick up your child?

Parent/Guardian Authorization - Release
I am the parent or legal guardian of "the participant" who has my permission to participate in all program s and activities in Camp Tikkun Olam. I recognize and acknowledge that participation in the camp necessarily involves the risks of accident, personal injury and/or property damage. I consent to the Participant’s participation in the camp and assume all these risks in connection with the camp. Participating in any activity is an acceptance of some risk of injury and I agree that the Participant is primarily dependent on his/her taking proper care of him/herself. Accordingly, in consideration for Chattanooga First Church of the Nazarene and the Jewish Federation of Greater Chattanooga (hereafter called the organizations) allowing the Participant to participate in the camp, I hereby release both organizations, its officers, directors, employees, agents, and volunteers from any and all claims, causes of action, injuries, damages and liabilities allegedly caused by any negligent act or omission of the organizations, arising out of or relating to participation in the camp. Additionally, in consideration of the organization’s allowing the Participant to participate in the camp, I hereby agree to indemnify and hold harmless the organizations for any and all costs, losses, damage, or expense, including attorney’s fees, arising out of any claim for personal injuries allegedly caused by any negligent act or omission of the organizations, arising out of or relating to participation in the camp. I agree that Participant is attending the camp voluntarily and for purely recreational purposes. Additionally, I agree to allow the organizations to use pictures of my child for promotional and news purposes. I agree to allow the organizations to transport my child to and from program activities by licensed adults over the age of 18, in private or the organizations vehicles or in the event of an emergency.
Parent/Guardian Signature*

Date
Month
Day
Year

Medical Information
Camper Full Name
First Last
Physician Name
First Last
Phone
Insurance Company

Policy Number

Date your child last received MMR shot
Month
Day
Year

Date your child last received Tetanus shot
Month
Day
Year

Does your child have any allergies (such as food allergies or bee stings) that we should be aware of?*
If yes, please explain:

List any conditions that may have been diagnosed by a physician, pyschologist, or psychiatrist:

Does your child have any learning or behavior challenges?

If no, you may enter "no."
Does your child have any special conditions not already addressed? If so, please describe:

Will your child be taking any medication, including over-the-counter, during summer camp?*
This includes medicines taken before arriving and after departing summer camp.
Will the organizations staff be required to administer the medication for the child?*
Will your child be taking any medications beyond their expiration date?*
The organizations staff cannot administer expired medication.
If you answered yes above, you must provide the medications and complete the information below.
Medication

Dosage Amount

Schedule or indication of taking medicine

Additional medicine, dosage amounts, and schedule of taking the medicine
Enter medication, dosage amount, and schedule or indication of taking the medicine.
Special activities to be encouraged or restricted

Special dietary regimen to be followed (e.g. vegetarian, lactose intolerant)

Does your child carry an Epi-pen?
See Doctor's Authorization below
Doctor's Authorization
If the organizations staff needs to administer an Epi-pen, you must obtain the prescribing physician's authorization.
Doctor's Name

Doctor's Signature

Date
Month
Day
Year

Medical Authorization
I authorize the Organizations staff to give the medications listed to my child: over the counter, prescribed, emergency medicines - Epi-pen etc. I authorize the organizations staff to give permission for medical treatment of my child in the event of an emergency. I also certify that the personal and medical information contained herein is true and correct to the best of my knowledge.
Parent/Guardian Signature

Date
Month
Day
Year

PHILANTHROPY CAMP BEHAVIOR CONTRACT
Parent/Guardian(s) are required to discuss the following with their child:
Camper Expectations/Behavior Contract:

1. Always follow the directions of the Camp Directors, and the adult and teen counselors.
2. Always stay with the group.
3. Be courteous to others. Remember to treat others as you would like to be treated.
Keep your hands, feet and other objects to yourself. 4. Pay attention and listen when someone else is speaking.
5. Always use respectful language and be helpful to others. Your helping hands will make Philanthropy Camp a wonderful experience for you and all other campers.
6. Always talk to a counselor or another adult if you have a question or a problem during camp. We want to be able to help you with anything that you are uncomfortable with.

The camper should recognize that his/her actions can positively or negatively impact the camp community. The camper must follow the above expectations, and comply with the general rules set out by Philanthropy Camp. Everyone at camp will work diligently to create a safe and enjoyable environment so all may enjoy the benefits of a healthy and happy summer camp atmosphere.

Should a camper demonstrate inappropriate behavior, the following steps will be taken:

• Counselors will discuss the behavior with the camper.
• The camper will be given a “time out” or will not be allowed to participate in a subsequent activity.
• Counselors will discuss the behavior with one of the Directors.
• The Director will discuss the situation with the parent/guardian.
• The parent will be called to pick up his/her child from camp immediately.
• The child may or may not be permitted back at camp.

Note: There are no refunds when a child’s own behavior requires he/she be sent home.
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I have read and understand the Philanthropy Camp Behavior Contract, and I have discussed it with my child in a manner that he/she can understand.
Camper's Name

Camper's Signature

Parent/Guardian Signature

Date
Month
Day
Year

PHILANTHROPY CAMP - IMFORMATION SHEET AND FAQS
What ages can attend? Philanthropy Camp is for rising 1st through rising 6th graders. Does Philanthropy Camp offer before and after care? No. Philanthropy Camp does not offer before or after care. Campers must be dropped off and picked up at the times specified for camp. The Philanthropy Camp is full! What do I do? It is important to get on the waitlist! Unless you tell us otherwise, we will put you on the waitlist, and hold your payment. If your child is unable to attend because camp is full, we will return your payment to you. My child is on a waitlist; how do I know when a spot becomes available? As soon as a spot becomes available, we will call you using the contact number(s) you have listed during the registration process. Please make sure these numbers are updated. The spot will be held for 24 hours and then be offered to the next registrant on the waitlist. Please do not call to check on waitlist status. May I put my child in camp if they will be in kindergarten or going into the 7th grade in the fall? No. The camp has been developed for specific age groups, and we require that campers register for the appropriate camp. Philanthropy Camp is for rising 1st graders through rising 6th graders. Will my child need to pack a lunch? Yes. Campers are given snacks and drinks during the day, but it is required that they bring a packed lunch. Lunches should be vegetarian, and they should not contain any meat products. A suggestion list will be available. The packed lunch should include a drink that does not require refrigeration. Please include a refillable water bottle in your child’s pack. Please alert us to any food allergies! What other items should I pack for my child’s day at camp? Once we receive your completed registration form and payment, we will send you a supply list for camp. What should my camper wear? Comfortable summer clothes, closed-toe sneakers (Please, no flip-flops).
Payment for Camp
Amount to be charged for Philanthropy Camp Tuition*

Enter a $ amount for the number of children you are signing up for camp. Tuition is $125.00 for the 1st child and $110.00 for additional children.
Amount to be charged for Sponsorship

Enter a $ amount if you'd to sponsor a child for philanthropy camp. We thank you for your generosity.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
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Mon – Thur	9:00am – 5:00pm
Friday	9:00am – 4:00pm