Thank you for filling out the Dream Camp re-enrollment application.
This application is only for campers who attended camp during the summer of 2016.
Applications for re-enrollment must be submitted by April 15th.
Start
 
Child's First Name *

 
Middle Initial

 
Child's Last Name *

 
Birth Date *

 
Height

 
Weight

 
Grade for the 2017-2018 school year. *


 
School *

 
Is this your child's first year at Dream Camp? *

     
 
If not, what was your child's first year?

 
Insurance Carrier *

 
Insurance ID #

 
Physician's Name

 
Physician Phone #

 
Medical Information.
*please check all that apply. *


 
Please Explain Medical Information

 
Briefly describe your child's personality. (i.e. shy, outgoing, etc.) *

 
What would you like your child to gain from his/her camp experience?

 
Parent/Legal Guardian Information.

 
1. Parent/Legal Guardian Name (First, Last) *

 
Relationship to Child *

 
Daytime Phone *

 
Cellular Phone

 
2. Parent Name (First, Last)

 
Relationship to Child

 
Daytime Phone

 
Cellular Phone

 
Child's Home Address.

 
Street. *

 
City, State *

 
Zip Code (XXXXX)

 
Who should receive correspondence at the above address? *


 
Your child lives with: *


 
Are there any custody issues? *

     
 
If yes, please explain

 
Please list any siblings of the camper applicant (include name, birthdate, grade, and the school they attend).

 
Emergency and Security Information.

Who are the emergency contact persons in the event that parents/legal guardians are unavailable?
 
1. Emergency Contact person Name *

Who are the emergency contact person(s) in the event that both parents/legal guardians are unavailable?
 
Relationship to camper. *

 
Primary Phone. *

 
Additional Phone.

 
2. Emergency Contact person(s). Name. *

Who are the emergency contact person(s) in the event that both parents/legal guardians are unavailable.
 
Relationship to camper. *

 
Primary Phone. *

 
Additional Phone.

 
1. Pick up permission. (Name, Relationship, Cellular Phone). *

Who is permitted to pick up your child(ren) from camp?
 
2. Pick up permission. (Name, Relationship, Cellular Phone).

Who is permitted to pick up your children from camp?
 
3. Pick up permission. (Name, Relationship, Cellular Phone).

Who is permitted to pick up your children from camp?
 
4. Pick up permission. (Name, Relationship, Cellular Phone).

Who is permitted to pick up your children from camp?
 
Camper Security Password.

Please provide us with a "camper security password" which will be required by Dream Camp when you are requiring pertinent camper information, or making changes to your child(ren)'s schedule.
 
Password

 
Password Reminder

 
Busing Information

Dream Camp provides transportation to all campers residing within the City of Hartford.  Children enrolled in Day Camp (1st - 4th graders) are eligible for door-to-door transportation.  Children enrolled in Sports Camp (5th grade & older) are assigned a pick-up & drop-off location at a school near their house.  Busing assignments are determined at Family Orientation, prior to the start of camp.
 
I will provide daily transportation for my child(ren). *

     
 
I will need busing for my child(ren) in the morning, before camp. *

     
 
I will need busing for my child(ren) in the afternoon, after camp. *

     
 
Club O.T.

Dream Camp also offers an extended day program, Club O.T., for families who opt to provide their own transportation.  This program allows parents to drop children off as early as 8:00 AM and pick up as late as 5:15 PM.  The extended day program is not available for children enrolled in bus transportation.

 
Household Information

ALL INFORMATION BELOW MUST BE PROVIDED IN ORDER FOR THE APPLICATION TO BE CONSIDERED.
 
Does your family receive TANF? *

     
 
Does your family live in subsidized housing? *

     
 
Family Income *

 
Above income is received: *


 
How many people live in your household? *

 
Please check all that apply: *


 
Please indicate the primary language spoken in your household: *


 
Please indicate the highest education level attained by a member of your household: *


 
Race/Ethnicity. *


 
Annual Parent Questionnaire:

This information is for data collection purposes only and will not affect your child's enrollment. This questionnaire must be completed to be considered for enrollment. In addition to this enrollment application, please submit a copy of your child's most recent report card and State test scores for our records.
 
Do you assist your child with homework? *


 
Please check all that apply.


 
In the past year, has your child received all A's and B's on a report card? *


 
In the past year, has your child received any D's or F's on a report card? *

     
 
If yes, what subject?

 
Please check the boxes that apply to the activities that your child is involved in:


 
If other, please describe.

 
Please rate your child's daily behaviors. *


 
Has your child ever been suspended or expelled from school? *

     
 
If yes, please explain.

 
In the past year, has your child ever been involved in any physical altercations at school or outside of school? *

     
 
If yes, how often?

 
Has your child ever had access to weapons and/or illegal substances? *

     
 
If yes, please explain.

 
To your knowledge, has your child engaged in any high-risk behaviors, including alcohol, tobacco, or drug use? *

     
 
To help us serve your child, please provide us with further information about his/her history. Check all that apply below. *


 
Please feel free to explain any additional information below:

 
Do you have any suggestion for the improvement of Dream Camp?

 
Please read and accept below. Clicking accept is the equivalent to a signature. *

On behalf of my child, I accept and assume any and all risks associated with his/her attendance and participation in the camp and its activities. I understand that my child should not attend the camp if he/she is not healthy. I understand that my child must abide by camp policies and the instructions of the camp staff. In the event that I can not be contacted in an emergency, I hereby
grant ESF, Inc.(ESF) permission to give immediate treatment and/or take my child to a hospital emergency room. Permission is hereby granted for photographs and/or videos to be taken of my child at camp and ESF has the right to utilize these in our brochures, videos, slide shows, web site and other camp materials. Knowing these facts and in consideration for your accepting my child’s application, I, for myself, my child attending the camp, and anyone else who might claim on my or my child’s behalf (“I”), hereby agree that neither ESF, ESF Dream Camp Foundation, nor Trinity College are responsible for accidents, injuries, and/or medical or dental expenses arising from my child’s participation in the camp and/or as a result of my child being bused to and from camp. Accordingly, I covenant not to sue, and waive, release, and discharge ESF, ESF Dream Camp Foundation, and Trinity College and anyone working on their behalf from any and all claims of liability or expenses of any kind or nature whatsoever arising out of or relating to my child’s participation in the camp. I consent for Dream Camp to have ongoing communication with my child’s school concerning my child’s progress. I also agree to let Dream Camp receive report cards and health information that the school may have on record for my child. Finally, I agree to allow communication between my child’s teacher(s) and a Dream Camp representative. I have carefully read all of the information in this application form and agree to all conditions.
     
 
Health Form and Medication Information:
Changes for 2017
Please read and accept. *

ALL Health Forms and medication MUST be brought in to the camp office by Thursday at noon, the week before camp, June 22nd.

If a camper does not turn in their health form or medication, they may not attend camp for at least 24 hours after handing in the required items.

If your child's physician lists an inhaler or epi-pen (or similar product) on your child's health form, your child MUST have it at camp. Your camper will be sent home if it is not brought to camp.
     
 
Thank you for taking the time to fill out the application on-line.

Please submit this form as soon as possible, but no later than April 15th. Applications received after April 15th, will not be granted re-enrollment.  NO EXCEPTIONS will be made. If we receive your application after April 15th your child will be placed on our Waitlist. *

If you have any questions or concerns, please feel free to contact us at: agillon@esfdreamcamp.org or 860-987-6209.

Please indicate that you read the above re-enrollment information by selecting I accept.
     
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