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SUMMER DAY CAMP
Registration Form

Thank you for choosing to the HLIC Summer Day camp for your child. 

To reserve a place for your child you must provide the following:

  • Registration form (includes waiver and release) AND

  • Payment (2 weeks summer day camp, $625 due before your selected camp start date)

Camper Information

Primary Caregivers

Authorized Pick-Up (if different from primary caregivers)

Child will be released to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached.

  • DO NOT put anyone on this form that cannot pick up your child. If both parents are listed, that indicates to us that either parent is authorized to pick up your child unless otherwise noted.

  • All persons authorized to pick-up children should be prepared to show identification (photo i.d.) at the time of sign-out for the child to be released to them; and must be at least 18 years old

Camp Date

Please choose the camp dates you wish to register for

Additional Information

Media Consent: My child's picture can be taken while participating in HLIC events/activities with the knowledge that the photo may be used by HLIC (print materials, online, website).
Transportation & Activities Consent: My child has permission to be transported by HLIC by walking or (supervised) public transit and to participate in all HLIC program activities, special events, and related field trips.

Waiver of Liability

I expressly acknowledge that certain dangers, risks, illnesses and personal injuries are inherent in participating in the HLIC's programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries. I understand that HLIC and its employees assume no responsibility for loss, damage, illness or injury to person or property to any participant applicable. I expressly acknowledge, on behalf of myself and my minor child(ren) and ward(s), that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my minor child(ren)'s or ward(s)' participation in any events/activities/programs/classes while at or under the supervision of HLIC.

I have read, understood and agree to the Waiver of Liability

Parental Agreement

  1. HLIC agrees to notify the parent/guardian whenever the child becomes ill and the parent/guardian will arrange to have the child picked up as soon as possible if requested by the HLIC.

  2. The parent/guardian agrees to inform the HLIC within 24 hours or the next business day after his child or any members of the immediate household has developed a reportable communicable.

  3. The parent/guardian agrees to refrain from sending the possibly ill child to HLIC, and understands that if a child shows symptoms of illness, the parent/guardian will be called to have the child removed from camp.

  4. The parent/guardian authorizes the application of sunscreen and/or insect repellent for his/her child by HLIC staff.

  5. Late pick-up: If a parent/guardian/Authorized pick-up person is unable to pick up the child from HLIC by 5:00 PM each day, they agree to call HLIC staff to inform them. Failure to call when late will result in HLIC staff calling ALL of the child's Parents/Guardians and Authorized Pick-Up Contacts. If HLIC cannot reach any adult (that is listed in the child's registration form) by phone at the time of pick-up, and no adult has contacted HLIC regarding the child's pickup, authorities may be called.

I have read, understood and agree to the Parental Agreement

Cancellation and Refund Agreement:

  1. Cancellation (withdrawing the child from the camp) must be made at least 2 weeks in advance of the camp start date.

  2. No refunds will be made for cancellations within 2 weeks before the start of the camp week or after the start date has passed.

I have read, understood and agree to the Cancellation and Refund Agreement:

Registration Agreement:

  1. I understand that I must pay the camp fee ($600 per 2-week camp) for my child to be registered in a camp.

  2. I understand that until a payment is made, my child is not registered in the camp/cannot participate in the camp. If a payment is not made, the registration is considered invalid.

  3. An email with payment instructions will be sent when this registration form is submitted. Payments can be made by PayPal, or in person at the HLIC office (1969 Upper Water Street, Purdy's Wharf Tower II) by cash, debit or credit card.

I have read, understood and agree to the Registration Agreement:

Thank you for registering your child for Summer Day Camp at HLIC!

You will receive a confirmation email with payment instructions shortly.

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