Acceptance form - Steve's Camp

Steve’s Camp Acceptance form

Welcome to Steve’s Camp! Below you’ll find two main sections of information to be completed by the camper and their caregiver prior to the first day of camp.

In “Permissions & Safety,” we ask caregivers to confirm their consent regarding medical interventions (if necessary), transportation, and media consent for the camper. We also ask for emergency contact information, including health insurance.

Another important way we ensure the camper’s safety is to make sure all of the campers' families commit to a shared set of values prior to the start of camp. The “Camper Commitment Contract” informs the camper and their family about what is expected of the camper at camp this summer.

Note: Once you start this form, you must complete it. Unfortunately, you cannot save a partially completed application and return to it later.

Camper first name

Camper last name

Camper date of birth

Caregiver first name

Caregiver last name

Caregiver phone number

Caregiver email address

Camp session

Select the camper's program

Permissions & Safety

To be completed by the caregiver.

General Release

I permit this camper to attend Steve’s Camp.

I give consent for the camper to participate in all camp activities during the session they have been chosen for.

There is no other person whose consent is required (such as another parent whose consent is required under a court decree) to permit the camper to attend the programs offered by Steve’s Camp.

I agree to let my child be tested for COVID-19 before and during the camp session.

In the event that the camper is injured or becomes ill during any Steve’s Camp program, I accept and authorize emergency medical care provided that, in the opinion of treating medical staff, such action is advisable.

I indemnify and hold harmless Steve’s Camp, as well as its employees, volunteers, or agents, for any and all liability for damages, losses, or injuries, whether to person or property, that the camper may incur while participating in any activity conducted by or in connection with Steve’s Camp, including but not limited to transportation.

Transportation Release

I give the camper permission to be transported to camp and return via a licensed bus company. (See Step 4 in the Camper Resources page for all drop-off and pick-up information.)

I give the camper permission to travel via van for activities, and in the case of emergency.

If the camper tests positive for COVID-19, I agree for staff to transport my child back to the city.

Media and Camper Survey Release

I hereby consent to the camper’s participation in interviews and use of their quotations and also give permission to Steve’s Camp, or an organization acting on their behalf, to take photographs, movies, and video recordings of the camper.

I consent to the camper’s participation in a 20-minute evaluation (survey) at the end of camp to understand their overall Steve’s Camp experience.

I understand that all data obtained from the camper by the survey will be kept confidential and will be used by staff to increase the quality of the program.

I have answered all the above questions truthfully, and I certify that answering “yes” is the same as signing my signature.

Emergency Contact Information

In the event of an emergency, this is the person whom Steve’s Camp will contact:

Emergency contact first name

Emergency contact last name

Phone number

Email address

Health Insurance

Health insurance name and policy number

Please upload a copy of your health insurance card

Camper Commitment Contract

To be completed by the camper (with their caregiver present).

I understand being a camper at Steve’s Camp is a special opportunity, and I will not back out of my commitment to attend at the last minute.

At camp, I will arrive on time for each session, according to the schedule provided to me.

I will be open to new experiences, new foods, and new friendships through my camp experience.

I will follow the camp values (real honesty, real safety, real courage, real respect, real caring, real sharing) when interacting with my fellow campers and staff.

I will follow all rules set by the program and be responsible and respectful of the camp equipment and property.

I agree to take a random COVID-19 test during the session, if necessary.

If for reasons I cannot control I am unable to attend Steve’s Camp, I will contact the Camp Director, Amy Stonionis, a minimum of 3 days prior to the departure date.

I have answered all the above questions truthfully and I certify that answering “yes” is the same as signing my signature.

Please attach the letter of recommendation from your teacher, counselor, or community mentor as a PDF below: