Camp Mania Participant Information Form

Participant's First Name

(Child's Name)

Participant's Last Name

Current Session

Age

Date of Birth

Participant 1 Shirt Size

Add Another Child

Address

Does the camper need a floatation device?

We will be having swimming days for Camp Mania. Does the camper need a floatation device such as a lifejacket. Also, please complete the Swimming Consent Form at https://experienceslk.com/CampManiaSwim.

Parent Information

Please List all Parent Information in case of emergencies.

Parent(s) First and Last Name

Parent Email

Parent Phone Number

Secondary Phone Number

Emergency Contact Information

Please list an emergency contact other than parents.

Emergency Contact First and Last Name

Emergency Contact Phone Number

Relationship to Particpant

Authorized Pick-Up Information

Please list all people (including parents) who is authorized to pick-up your child. Your child will only be released to this listed below. Must be 16 years of age and photo ID is required by parents and any additional listed to pick-up your child. Up to four Authorized Pick-Ups can be added, if you would like to add more, please contact Programs Staff at programs@cityofsouthlake.com.

1. Authorized Pick-Up First and Last Name

2. Authorized Pick-Up First and Last Name

Click below to add another Authorized Pick-Up

Medical Information

Will your child need to take any medications during the program hours?

If answer is yes, please fill out this form: https://experienceslk.com/MedicationForm.

Yes

Does your child have allergies, chronic illnesses, or dietary needs?

Yes

Are there any special needs or accommodations that staff should be aware of?

Yes

Fair Play and Behavior Policy

Southlake Community Services strives to provide personal growth in a safe environment by following the Fair Play and Behavior Policy. Individuals participating in Southlake Community Services programs are expected to: 1. Wear appropriate attire. 2. Refrain from using profane language. 3. Refrain from placing themselves and/or others at risk (i.e. hitting, fighting, biting, kicking, spitting, etc.). 4. Respect other participants, staff, and things belonging to others. 5. Participate in activities, remain with staff, refrain from disrupting program activities, and follow directions to the best of their ability. *Persons endangering the safety of themselves or others will be removed from the facility or program. Other infractions of rules will be handles as deemed necessary by Community Services staff.*

I have read the Fair Play and Behavior Policy and will review the expectations with my child.

Send me a copy of my responses

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