PCNS Summer Camp Forms

INSTRUCTIONS:

Please completely fill out and submit one Summer Camp Permission form for each child attending Summer Camp at PCNS.
Forms must be submitted before children start their first session of Camp.
Session 1 starts 7/10
Session 2 starts 7/10
Session 3 starts 8/7
Session 4 starts 8/14

Please note there are areas in this form requiring electronic signatures as well as several links to documents parents need to review.
(Review of the documents is a requirement by our licensing by the Dept. Of Children and Families in NJ)

If you have any questions, contact the director at jmueller@pcmorristown.org or via Messaging in the Brightwheel App.

Child & Family Information

Child's Name

Date of Birth

Parent /Guardian 1 Name

Parent/Guardian 1 Cell Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Cell Phone

Family Email

This address will receive a confirmation email

Family Address

Emergency Contact Information:

All Families must provide us with 2 emergency contacts.

Emergency Contact # 1 Name

Emergency Contact # 1 Relationship (i.e.grandma, friend, etc.)

Emergency Contact # 1 Phone

Emergency Contact # 2 Name

Emergency Contact #2 Relationship (i.e.grandma, friend, etc.)

Emergency Contact #2 Phone

Medical Authorization/Non Custodial Pick Up Notice:

In the event that a medical emergency occurs while my child is at summer camp, I authorize the Presbyterian Church Nursery School to seek emergency medical care for my child as deemed necessary by the Director and/or staff.

I hereby grant permission for the Director or Acting Director to take whatever steps may be necessary to obtain emergency medical care if warranted.

These steps may include, but are not limited to, the following:
1. Attempt to contact a parent or guardian.
2. Attempt to contact the child’s physician.
3. Attempt to contact you through any of the persons listed on the emergency contacts listed above.
4. If we cannot contact you or your child’s physician, we will do any or all of the following:
(a) Call another physician,
(b) Call an ambulance,
(c) Have the child taken to an emergency hospital in the company of a staff member.
5. Any expenses incurred under item 4 above, will be borne by the child’s family.

Please Type your First and Last Name:

I understand by typing my name above and checking YES constitutes a legal signature of approval for emergency medical care

Yes No

Non Custodial Parent

If a non-custodial parent is not included among those persons authorized by the custodial parent to pick up the child please submit a copy of the appropriate documents (court order) with a written note explaining this to the director.

Documents To Review:

LINK TO POLICY DOCUMENTS
1. Information to parents
2. Policy on the Release of Children
3. Positive Guidance & Discipline Policy
4. Expulsion Policy
5. Policy on Communicable Disease Management
6. Communicable Disease Chart
7. Policy on Parental Notification Methods

I understand that checking YES constitutes my signature that I reviewed the 6 documents listed above

Yes No

More Documents To Sign:

Please follow the links to our
1. Permission to Use School Equipment and Building Spaces:

2. Policy on the Use of Technology and Social Media

Please sign your permission below (your typed name here constitutes a legal signature):

Type your first and last name:

I understand that by typing my name above and checking YES here constitutes agreement with the Permission and Social Media documents listed above:

Yes No

Summer Camp Health Forms

Please follow the link for the Universal Health Record.
ALL NEW CAMPERS ARE REQUIRED - IF YOU HAVE A CURRENT PCNS STUDENT, AND YOUR CHILD'S IMMUNIZATIONS ARE UP TO DATE, YOU DO NOT HAVE TO SUBMIT ANYTHING FOR SUMMER CAMP:
1. Print this form
2. Parents must fill out the first section of the form
3. Your child's pediatrician needs to fill out and sign section 2 of this form.
4. Submit the health form along with your child's vaccine records before they attend summer camp.
5. If your child has a food allergy, please print the Allergy Action Form and have it signed by your child's pediatrician.
6. All medication for food allergies MUST be in original container and labeled with your child's name. Place all medications in a zip lock container labeled with your child's name.

Description

Back to School documents for PCNS.

PCNS Summer Camp Forms

Description

Please Fix the Following