Fillable Miami-Dade County Parks, Recreation and Open Spaces Department

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Miami-Dade County Parks, Recreation and Open Spaces Department

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Miami-Dade County
Parks, Recreation and Open Spaces Department
SUMMER CAMP PROGRAM
Dear Parents/Guardians:
WELCOME!
We have an outstanding summer planned for you! Our goals this summer are to provide campers with a
safe, quality experience that awakens new interests, promote new skills, create discovery, awareness, and
build new friendships all in accordance to CDC, American Camp Association, and Miami-Dade County
Health and Safety Guidelines in light of current conditions for coronavirus exposure in our community.
Please note the information below regarding this year’s program.
Early Drop Off: 7:30 AM – 9:00 AM
Program Hours: 9:00 AM – 5:00 PM
Late Pick-Up: 6:00 PM
No participant will be allowed to be dropped off after 9:00am or picked up before 4:30pm. If a participant
must be picked up early, prior notification is required.
Summer camp fees are due on the Friday prior to the week of attendance or no later than Monday
mornings when your child is dropped off. We encourage all parents to please pay online at
www.miamidadeparks.com Please note the Refund Policy within this registration packet.
Late fees will accumulate at the rate of $5 for every fifteen minutes starting after 6:15 PM and will be applied
to your weekly fee.
Campers must complete a daily wellness check at drop off and wear a face covering before exiting
the car. The authorized persons listed on the registration form are the only individuals we will allow your
child to depart camp with. Parents are asked to notify staff regarding individuals not listed on the registration
form. For the protection of all campers, all pick-up persons should be prepared to show a valid picture ID.
Please make sure your child’s belonging are labeled. We are not responsible for any lost or stolen items.
Campers are asked to wear weather appropriate “play” clothes each day. Closed toe athletic shoes and
face coverings are REQUIRED. During program hours, it is prohibited to use or display skateboards,
bicycles, cellular phones, MP3 devices, mobile video game systems, and any other electronic devices.
Please discuss meal options with your respective Site Manager.
Please refer to the back of the registration form for additional information regarding the Summer Camp
Program.
For more information on our program’s response to the current coronavirus exposure, please see the list of
Frequently Asked Questions included in this registration packet.
We look forward to a great summer!
Miami-Dade Parks, Recreation and Open Spaces Department
PROGRAM REGISTRATION FORM
PARK NAME:
_________________________________________
DATE: ____________
ADDITIONAL EMERGENCY CONTACTS/AUTHORIZED TO PICK-UP
Participant Last Name:
Participant First Name:
Date of Birth:
School Attending:
Student ID#:
Parent / Guardian Name:
Mobile Carrier:
Date of Birth:
Address:
City:
State:
Zip:
Email:
Alternate Phone Number:
Participant T-Shirt Size:
Secondary Guardian Name:
Phone Number:
Email:
Name:
Relationship:
Phone:
Alternate Phone:
Name:
Relationship:
Phone:
Alternate Phone:
Name:
Relationship:
Phone:
Alternate Phone:
I hereby release Miami-Dade County Parks, Recreation and Open Spaces from all liability for any accident or injury that might be
sustained through this Participant’s participation in this program.
Parent/Guardian Signature
I hereby authorize and give consent to Miami-Dade County Parks, Recreation and Opens Spaces Department to obtain medical
treatment for this Participant in the event of injury or emergency concerning his/her participation in or attendance at all
program related activities in the event that I can’t be reached to provide consent.
Parent/Guardian Signature
Does the Participant have health insurance?
Yes - Insurance Company: ___________________ Policy #:_________________ Policy Holder: ________________________
No - I will pay any and all medical bills for emergency care for this Participant
Parent/Guardian Signature
I hereby authorize representatives of Miami-Dade County Parks, Recreation and Open Spaces to transport the Participant to and
from destinations (field trips, special events, scheduled games, etc.) for program purposes only.
Parent/Guardian Signature
I hereby give Miami-Dade County Parks, Recreation and Open Spaces permission to use any picture, live television, video tape,
digital or audio recording of the participant captured while participating in MDPROS programs and events while utilizing
facilities for promotional purposes. I fully understand that the Participant will not be compensated for the use of the image.
Parent/Guardian Signature
I hereby grant consent for the participant to leave the park unsupervised after __________P.M.
Parent/Guardian Signature
After School
Winter Camp
Spring Camp
Summer Camp
Other:__________
PROGRAM NAME:
TCT FIT-2-PLAY FIT-2-LEAD Other: __________________
122.05.9 Rev 3/21
Does the Participant have a medical condition that staff should be aware of (i.e., allergies, asthma, diabetes, epilepsy, etc.)? Yes No
If yes, please describe: __________________________________________________________________________________________________________
Is the Participant currently taking medication that needs to be taken during program hours? Yes* No
(*If yes, please adhere to our Medication Policy)
Does the Participant have a disability or behavioral challenge? Yes* No (*If yes, please complete an Inclusion Request Form)
If yes, describe: _________________________________________________________________________________________________________________
Will anyone be visiting the Participant during program hours (i.e., Therapist, Counselor)? Yes* No (*If yes, please adhere to our Visitation Policy)
To request materials in accessible format, sign language interpreters, and/or any accommodation to participate in any Miami-Dade Parks sponsored
program or meeting, contact Gisel Prado, 305-755-7848 or Gisel.Prado@miamidade.gov at least 7 days in advance to initiate your request.
TTY users may also call 711 (Florida Relay Service).
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Miami-Dade County
Parks, Recreation and Open Spaces Department
SUMMER CAMP PROGRAM
REFUND POLICY
Registration fees are $15.00 per child which is non-refundable. Participants will receive a
full refund if the program is cancelled by the Miami-Dade Parks, Recreation and Open Spaces
Department.
A refund will be given to participants withdrawing two (2) or more business days prior to the
program’s start date.
Participants withdrawing less than two (2) business days prior to the program’s start date may
receive a credit toward another program/activity sponsored by the Department. Some
restrictions may apply.
Refund requests must be made in writing by completing the Refund Request Form available at
the Park Office. Refunds take a minimum of six (6) weeks to process. Payments tendered by
checks must be cleared prior to the processing a refund request. Cash refunds are prohibited.
My signature below acknowledges that I have read and understand the Parks, Recreation and
Open Spaces Refund Policy for fees paid for programs/activities.
__________________________
Participant Name (Printed)
_____________________________ ________________________________
Parent/Guardian’s Name (Printed) Parent/Guardian’s Signature Date
LATE PICK-UP PROCEDURES
If a parent/guardian calls staff in advance to let them know that they are running late to pick up
a child, there will be a courtesy period extended to the parents. Thereafter, a fee of $5 for
every fifteen minutes starting after 6:15 PM will be charged to the weekly fee.
I understand that late fees will be charged if my child is not picked up in accordance with the program’s hours of
operation and the late-pick up procedures.
__________________________
Participant Name (Printed)
_____________________________ ___________________________________________
Parent/Guardian’s Name
(Printed) Parent/Guardian’s Signature Date
Miami-Dade County
Parks, Recreation and Open Spaces Department
SUMMER CAMP PROGRAM
DISRUPTIVE BEHAVIOR POLICY
Miami-Dade County Parks, Recreation and Open Spaces strives to provide a safe environment
for our program participants and staff. Parent cooperation and involvement is vital to the
success of our programs. We ask that parents read and discuss the rules and policies to their
child(ren). Park staff will use positive discipline techniques and corrective actions (e.g., positive
reinforcement, firm statements, and redirection) when working with Participants to enforce
appropriate behaviors. Although Staff is committed to correct inappropriate behavior, any
behavior that becomes offensive, disrupts the program, or endangers the well-being of an
individual will not be tolerated. If a Participant’s behavior endangers the safety of the
Participants/Staff around him/her, the program Supervisor has the right to terminate services
for the Participant. Each incident will be addressed on an individual basis according to the
severity of the behavior and at the discretion of the program supervisor. Group supervision is
provided for Participants; we are not staffed for one-on-one supervision. All behavioral issues
will be documented and discussed with the Parent/Legal Guardian. If necessary, a behavior
modification program will be developed and implemented. If inappropriate behavior continues,
the following consequences may occur: verbal warnings, supervised time away from the
program, limited/reduced time that the participant is allowed to attend the program, suspension
from the program, or removal from the program.
I understand that if my child continuously disrupts the daily operations of the program or causes ongoing
disciplinary problems, he/she may be asked to withdraw from the program without a refund.
__________________________
Participant Name (Printed)
_____________________________ _________________________________________
Parent/Guardian’s Name
(Printed) Parent/Guardian’s Signature Date
Miami-Dade
County
Parks,
Recreation,
and
Open
Spaces
Department
RULES AND REGULATIONS
Miami-Dade County Parks, Recreation, and Open Spaces Department provides supervised recreational programs for
the children of this community. For the safety and enjoyment of all participants, we ask that you review the following
rules and regulations with your child.
1.
Before participation in any program, the Parent/Guardian must complete the registration form and pay the
non-refundable registration fee, as well as any additional program fees that may exist. Refunds will be given if
the program is cancelled by the Department and/or if the registrant withdraws from the program two (2) or
more business days prior to the program start date. If withdrawing less than two (2) business days, the
registrant will only receive a credit towards another program (restrictions may apply). All refund requests must
be made in writing on a Refund Request Form.
2. MDPROS is not responsible for money, personal items, etc. lost during the program and will discourage participants
from bringing such items.
3.
Summer and Full-Day Camp
hours are 9:00 A.M. to 5:00 P.M., Monday through Friday. Early drop-off starts at
7:30 A.M. and late pick-up by 6:00 P.M. will be available.
Afterschool
hours start at 2:00 pm and late pick-up
by 6:00 pm.
a.
A $5.00 per child late pick-up fee will be charged for every 15 minutes that child is picked up late after
6:00 P.M. An authorized person must sign the participant in/out daily. In case of an emergency, if
someone who has not been previously authorized by parent/guardian comes to pick up a participant:
written consent by the Parent/Guardian must be given to the staff through email/fax with the full
name of the person, staff will match the consent to that of the person’s ID and a photocopy of the ID
will be kept in the participant’ file.
4.
In order to participate in fieldtrips, a signed permission slip for the participant must be on file at the park office
prior to leaving the park. Verbal permission will not be honored. Participation for various trips may be based
on honor points, attendance, conduct, and/or permission slips turned in on time.
5.
Bicycles, skateboards, cellular phones, any electronic devices are prohibited during program hours.
6.
Participants should bring lunch and snack daily unless otherwise specified. Refrigeration is not provided.
Athletic shoes and proper apparel must be worn at all times while participating in program activities. Please
mark all of the participant’s belongings so they can be easily identified.
7.
If the participant shows symptoms of illness prior to the day's activities, please make other arrangements. If
the participant becomes sick during the day, you must have them picked up right away.
8.
Medical insurance is not provided for participants. Should injury occur during any scheduled activity, it is the
Parent/Guardian’s responsibility to provide medical care for the participant.
9.
Group supervision is provided for participants.
Participants who do not stay with their groups will not be
allowed to remain in the program.
Rough
conduct, disrespect to staff, group disruptions, damage to
recreation property or equipment, vandalism, thievery, fighting, use of profanity, or any undesirable act
could result in the participant’s expulsion from the program. Any disciplinary problems will be discussed
between the Parent/Guardian and the Park Manager.
10.
MDPROS strives for inclusion within all programs. The Parent/Guardian of Participants with a disability or
behavioral challenge will be required to adhere to our Inclusion Process. An inclusion plan will be developed
at least 2 weeks prior to the start of the program, if needed, so to evaluate and determine reasonable
accommodations. In some cases, accommodations may take longer.
I have read and reviewed the above rules.
_________________________________ ______________________________ _______________
Parent/Guardian Name (Printed)
Signature Date
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Completed 2 May 2021

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