Foster Care Registration

Foster Care Registration Form

2024 Summer Camp

Camp Elite will be offering our fourth annual summer camp for our community. This is an 8-week program from June 3 – July 26. Summer camp will be held Monday – Friday, 8am - 3pm. Transportation will be provided if needed.

Activities will include art projects, ﬁeld trips, cultural awareness activities and water days. Each day, the activity will be tied to our weekly behavioral health themes. A more detailed calendar of events will be sent home towards the end of May.

Week 1 – Social/Emotional Skills

Week 2 – Anger Management

Week 3 – Self-Esteem/Advocacy

Week 4 – Resilience

Week 5 – Communication

Week 6 – Life Skills/Daily Living Skills

Week 7 – Positive Peer Relationships / Bullying

Week 8 – Coping Skills

MONDAYS - Art Day / Physical Development / Cooking & Baking

TUESDAYS - Water & Science Day

WEDNESDAYS - Field Trips/ Book Clubs

THURSDAYS - Cultural Awareness Activities / Gardening / Music & Movement

FRIDAYS - Water & Science Day

Each camper will receive a clear drawstring backpack, water bottle and camp shirt. The participant will be required to wear their camp shirt as much as possible. Parents/Guardians are responsible for cleaning the camp t-shirts.

Campers in the summer camp program will be based on good behaviors and engagement in all behavioral health activities. Elite has planned two incentive trips during the 8-week program, and campers will be eligible to attend only if they are participating and engaging appropriately throughout all other activities.

Elite is planning an end-of-summer showcase where we will display camper’s artwork, photographs and videos of our outings. We will also highlight our sponsors and team that made Camp Elite possible. This is tentatively scheduled for July 26, 2024 and we will invite parents, guardians, case managers and sponsors. The photos or videos will not be shared with anyone outside of Elite & their families and case managers. More details for this event will be sent out later in the summer.

PARTICIPANT INFORMATION:
Child Information:
Child's Name

First NameMiddle NameLast Name
Gender
Birth Date

MonthDayYear
School Name
Grade
Age
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Home Phone #
Child lives with:
Person responsible for payment:
Parent/Guardian #1

Contact Information
Name

First NameLast Name
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #
Work Phone #
Cell Phone #
Fax #
*Email*
example@example.com
Occupation:
Employer:
Parent/Guardian #2

Contact Information
Name

First NameLast Name
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #
Work Phone #
Cell Phone #
Fax #
Email
example@example.com
Occupation:
Employer:

Emergency Contact Information

Alternate Pickup/Release
Emergency Contact #1
Name

First NameLast Name
Relationship to Child:
Home Phone #
Work Phone #
Cell Phone #
Email
example@example.com
Emergency Contact #2
Name

First NameLast Name
Relationship to Child:
Home Phone #
Work Phone #
Cell Phone #
Email
example@example.com
Please list those people including in addition to parents/guardians who are permitted to pick up your child:
1. Alt #1 2. Alt #2 3.Alt #3

Medical Release Information
Insurance Information
Policy Number #:
Name of Health Insurance Provider:
Primary Physician Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #
Hospital Preference:
Medical Problems
Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures).
1. Medical Problem
Required treatment
Should paramedic be called?
2. Medical Problem
Required treatment
Should paramedic be called?
3. Medical Problem
Required treatment
Should paramedic be called?
1. Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
If Yes, Explain:
2.Is your child allergic to any type of food or medication?
If Yes, Explain:
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.

Terms of Agreement
Photo Release:

I hereby give permission for my child to be photographed during Camp Elite. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Feather River College Mountain Kids Camp and its affiliates.
Parent’s/Guardian’s Initials:
Camp Elite and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Children's’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).
Guardian Signature*

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Printed Name of Parent/Guardian:
Date

MonthDayYear
Date
Participation Consent Form: (Required)

I, the undersigned*, herby release discharge, indemnify, hold harmless and defend Elite Dream Center, its staff, and administration from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against the center due to death, personal injury or illness, loss or damage to property, or future causes that occur during the 2024 Camp Elite. In the event of any medical emergency, I authorize and consent for Elite to act on behalf for medical care deemed necessary for the participant.
Name of Participant:
Name of Parent:
Medical Insurance Company:
Policy Number #:
Family Doctor:
Phone #
Parent Signature*

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Contact Phone Number:
Date

MonthDayYear
Date

Services to Register
Please select the services your child would like to attend:
Camp Elite: please select the week(s)your child would like to attend

ALL: 6/3/24-7/22/24Week 1: 6/3/24-6/7/24Week 2: 6/10/24-6/14/24Week 3: 6/17/24-6/21/24Week 4: 6/24/24-6/28/24Week 5: 7/1/24-7/5/24Week 6: 7/8/24-7/12/24Week 7: 7/15/24-7/19/24Week 8: 7/22/24-7/26/24
Tutoring Services: please select the Wednesday(s) your child would like to attend

Every Wednesday between the dates June 12-July 24Wednesday, June 12, 2024Wednesday, June 19, 2024Wednesday, June 26, 2024Wednesday, July 3, 2024Wednesday, July 10, 2024Wednesday, July 17, 2024Wednesday, July 24, 2024
Dance Lessons: please select the Tuesdays(s) your child would like to attend

Every Tuesday between the dates June 11-July 23Tuesday, June 11, 2024Tuesday, June 18, 2024Tuesday, June 25, 2024Tuesday, July 2, 2024Tuesday, July 9, 2024Tuesday, July 16, 2024Tuesday, July 23, 2024
Music Lessons: please select the Tuesdays(s) your child would like to attend

Every Tuesday between the dates June 11-July 23Tuesday, June 11, 2024Tuesday, June 18, 2024Tuesday, June 25, 2024Tuesday, July 2, 2024Tuesday, July 9, 2024Tuesday, July 16, 2024Tuesday, July 23, 2024
Cooking Lessons: please select the Tuesdays(s) your child would like to attend

Every Tuesday between the dates June 11-July 23Tuesday, June 11, 2024Tuesday, June 18, 2024Tuesday, June 25, 2024Tuesday, July 2, 2024Tuesday, July 9, 2024Tuesday, July 16, 2024Tuesday, July 23, 2024
Should be Empty:

CAMP ELITE

LEARN MORE

Location

Camp Elite

1106 N. Arizona Ave

Chandler, AZ 85225

Contact

Need additional assistance? Please contact us:

eliteyfs1@gmail.com

480-628-5339

Hours

We are open Monday to Friday, 8:00 am to 5:00 pm.

Individualized treatment, counseling, mentoring, and support services for children, young adults and families that build upon positive relationships.

Individualized treatment, counseling, mentoring, and support services for children, young adults and families that build upon positive relationships.

Foster Care Registration

Foster Care Registration Form

PARTICIPANT INFORMATION:

Child Information:

Parent/Guardian #1

Parent/Guardian #2

Emergency Contact Information

Emergency Contact #1

Emergency Contact #2

Please list those people including in addition to parents/guardians who are permitted to pick up your child:

Medical Release Information

Insurance Information

Medical Problems

Terms of Agreement

Photo Release:

Participation Consent Form: (Required)

Services to Register

Please select the services your child would like to attend:

CAMP ELITE

Location

Contact

Hours