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City Of Newark

4311newark@ci.newark.nj.us

920 Broad Street, Newark, NJ, 07102, US

973-733-4311

Camp Watershed Online Application 2020

Thank you for your interest at Camp Watershed!!!

So that your application is submitted successfully and to avoid any delays, you will be required to upload the following documents: 

  • Parent/ Legal Guardian Photo ID Copy of child's Birth Certificate
  • Copy of child's Immunization RecordsMedical/ Insurance Card (if applicable)
  • Physical Exam (MUST BE SIGNED/STAMPED BY PHYSICIAN) *If the current physical exam is approaching expiration, you will be required to send an updated copy to our main office.
  • Inhaler, Medicine & Epi-Pen Form (MUST BE SIGNED/STAMPED BY PHYSICIAN)
  • 2020 Summer Food Service Program Form

*When uploading required documents, make sure that images are clear. If images are not clear, the application will not be processed. Without each one of the items above your application is incomplete and will not be processed.  

CAMPER'S INFO:

Date of birth:

Please upload a copy of camper's birth certificate, (Make sure the image is clear, as blurry images will not be accepted)

Click Here to Upload

LEGAL CUSTODIAL PARENT/ GUARDIAN INFO:

Please upload a copy of your government issued identification (license, passport, etc) (Make sure the image is clear, as blurry images will not be accepted)

Click Here to Upload

EMERGENCY CONTACT INFO:

CHOOSE YOUR PREFERRED SESSION

Which center would your child be attending?

~ Camper's Profile ~

The information provided will assist our staff in providing a positive experience for your child. Please answer by selecting the appropriate choices that best describes your child or filling in the blanks. All camper profiles will be handled confidentially. Information will be shared and discussed only as needed. Camp may request that an additional form be completed so that we can best plan for your child after reviewing the responses provided on this form.

At home, my child usually like to play:

My child's relationship with friends are:

My child interests are the following: (select all that apply)

At school, my child:

Please indicate your child's current general disposition and behaviors that most frequently occur: (select all that apply)

My child has a history of:

Does your child take any medication(s)?

My child has:

I am:

The following things does not make my child feel good: (select all that apply)

My child is angry when: (select all that apply)

When dealing with authority, my child:

~Parent & Camper Contract ~

If my child is accepted into Camp Watershed agree to:

• Allow my child to participate in all Camp activities including but not limited to athletic games, swimming, hiking, team-building activities, boating, special events, outdoor games, and ropes course activities.

• Send necessary medication (if my child requires medication).

• Notify the camp of any changes in my address or phone during the camp session so that I can be reached in an emergency.

• Authorize social service agencies, schools, clinics or doctors to release information, which the camp director feels necessary to best plan for my child at camp.

 

I also agree:

• That Camp Watershed will observe all reasonable precautions in providing for the care and protection of my child. By signing this application, I hereby release and hold harmless Camp Watershed, its directors, officers, employees, agents, and representatives from any and all damages, claims, injuries, and liabilities of whatever kind, including but not limited to claims for bodily injury or loss or damage to personal property, which may arise out of my child’s attendance at camp and out of his/her participation in any activities while in attendance.

 

I give my permission for Camp Watershed to:

• Have and use photographs, slides, video or other media of the applicant for its records or public relations (i.e., brochures, website, newspapers, newsletters, public presentations). You may refuse by crossing out the line above.

 

I understand:

• If my child comes to camp without necessary medication in original containers, he/she will be sit of activities that day.

• If my child demonstrates disruptive behavior, difficulty following directions, acts inappropriately in a group setting, participating in activities or following safety rules s/he may sit out for the remainder of the day AND if my child’s actions were extremely offensive/disrespectful s/he may be suspended from camp 1 or 2 days.

• If my child demonstrates disruptive, disrespectful behavior or has difficulty following directions three (3) times s/he will be ejected from the Camp Watershed program.

• There are inherent risks involved in the outdoor and active camp program that my child will participate in at camp.

• I will be available for the duration of my child’s participation at camp in case there is an emergency for which I need to be reached.

• Camp Watershed does not approve the use of any photographs, videos, or other representation(s) of campers or the Camp anywhere outside of the authorized Camp Watershed publications or presentations.

Terms and Conditions- Click the following to indicate that you have read and agree to the terms within the Parent Contract.

~Parent / Guardian Consent & Waiver/ Release ~

I, do hereby give my consent and permission for the above named camper to be transported to and from the City of Newark’s Camp Watershed and to participate in all activities. 

In consideration of the benefits to be derived from this activity, I hereby voluntarily for myself and anyone entitled to act on my behalf, waive, release, and forever discharge any claim or claims against, from the City of Newark’s Camp Watershed, the Department of Recreation, Cultural Affairs & Senior Services their staff and leadership in both their official and personal capacities, and any of its or their agents, assigns, representatives, successors, or anyone acting on its or their behalf, for any and all claims, demands or liabilities of whatever nature including but not limited to injury, death, or damage, whether in property or nature, which may arise in connection with said activities or any phase or parts thereof.

This waiver/release extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown, and includes liability that may arise out of negligence or carelessness on the part of persons named in this waiver/release. In the event of an emergency involving my child, where medical treatment is required, in the event I cannot be reached, I do hereby authorize and consent to any x-ray examination, anesthetic, medical, or surgical treatment rendered by a licensed physician. I understand that in the event of any such emergency, the Camp will attempt to notify me immediately based upon the contact information provided above. This completed form may be photocopied for trips out of Camp. 

I hereby certify that I have read this Consent and Waiver/Release, and I fully understand it. Click the following to indicate that you have read and agree to the terms within the Parent/ Guardian Consent & Waiver Release.

~ Health History Form/Permission to Treat ~

Does your child have medical insurance?

Please upload your child's medical insurance card. (Make sure the image is clear, as blurry images will not be accepted)

Click Here to Upload

Is camper a:

Has she had her first menstrual period?

Has she been told about it?

Is her menstrual cycle normal?

May she be given tampons?

Chronic or Recurring Illness/Medical Conditions: (Check all that apply)

Any Dietary Restrictions (i.e. vegetarian, no pork, lactose intolerance, etc.)?

Upload the 2019 Summer Food Service Program Form

Click Here to Upload

Any restrictions from camp activities?

A camp designee may administer the following over-the-counter medications to campers as needed and as directed by the package instructions. Please place a check next to any OTC medications that you DO give permission for the camp to administer to your camper.

Upload your child's current PHYSICIAN EXAMINATION FORM *If the current physical exam is approaching expiration, you will be required to send an updated copy to our main office. (Make sure the image is clear, as blurry images will not be accepted)

Click Here to Upload

Upload INHALER, MEDICINE and/or EPI-PEN PERMISSION FORM (Make sure the image is clear, as blurry images will not be accepted)

Click Here to Upload

Authorization for treatment and release: I hereby give permission to the medical personnel selected by Camp Watershed to dispense medications, provide routine health care, seek emergency treatments, order X-rays, routine tests, treatment, the release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Camp Watershed to secure and administer treatment, including hospitalization, for the person named above. The completed forms may be photocopied for trips out of camp. I understand that I may contact the camp and sign a waiver and refuse this permission to treat. In the event of an emergency where I cannot be reached or am unable to pick up my child, I hereby give Camp Watershed permission to release my child to the person(s) named as the second parent/guardian, emergency contact, or individuals appropriately indicated on the Camper Application Form.

Legal Custodial Parent/ Guardian Signature

Choose how to sign