Online Summer Camp Registration How To
Below is a full list of the Summer Camp Questionaire that you will be required to answer to register your child(ren) online.
Super Summer Day Camp 2020
Please complete this questionnaire. This information helps us to provide the best possible care for your child.
Grant Information
Grant Data Information
Thank you for completing the below information. We are proud recipients of the 21st Century Scholarship Grant and require the shared data to maintain an active status of this grant.
First Name | Middle Name | Last Name |
-Select One-FemaleMalePrefer not to answer
First Name | Last Name |
Please submit the home landline number if applicable.
First Name | Last Name |
Please submit the home landline number if applicable.
Please list an emergency contact other than the primary guardian(s).
First Name | Last Name |
Emergency contact other than primary caregivers phone number.
Ext:
-Select One-YesNo
-Select One-PreschoolKindergaten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade
Summer Camp Questionnaire
Summer Camp Questionnaire
Please answer all questions completely.
Numbers size comparison in parentheses.
Check all that apply.
Individual Educational Plan - If yes, please provide a copy of this plan to Liz Piazza at lpiazza@hobartymca.org
-Select One-YesNo
Create a 4 digit PIN number to allow us the additional security measure to serve your child. This PIN will need to be provided to make changes or updates to your child's account. Screenshot and/or save this PIN number for your record. If you forget or lose your PIN you will need to contact Liz Piazza at lpiazza@hobartymca.org
Please provide us with the most current and often viewed email address for you. We will send communication regarding your child, camp changes and or updates to this email address.
Ext:
Please provide us with the most current and often viewed email address for you. We will send communication regarding your child, camp changes and or updates to this email address.
Ext:
Please include individuals that that are NOT AUTHORIZED to pick-up your child from our care. If you have more than three (3) adults not authorized to pick up your child, please, contact Liz Piazza at lpiazza@hobartymca.org.
First Name | Last Name |
Please include individuals that that are NOT AUTHORIZED to pick-up your child from our care. If you have more than three (3) adults not authorized to pick up your child, please, contact Liz Piazza at lpiazza@hobartymca.org.
First Name | Last Name |
Please include individuals that that are NOT AUTHORIZED to pick-up your child from our care. If you have more than three (3) adults not authorized to pick up your child, please, contact Liz Piazza at lpiazza@hobartymca.org.
First Name | Last Name |
Medical Treatment Waiver
Medical Treatment Waiver
In case of an emergency this information will help us quickly support your child.
-Select One-A +A -B +B -O +O -AB +AB -Unknown
Please list all known allergies your child has. If your child doesn't have any allergies please, type N/A.
Please include any or all emotional or physical attributes to help us better support your child. If not applicable please, type N/A.
How can we support your child if he/she is feeling angry/sad/emotional?
case of an emergency, please list the authorized emergency room we may have your child treated by. If you do not have a preference we will have your child treated by St. Mary Medical Center.
the child does not have a primary physician. Please leave blank.
First Name | Last Name |
First Name | Last Name |
If the child does not have a dentist. Please leave blank.
First Name | Last Name |
Ext:
Does your child require our staff to administer medications? If so, please, contact Liz Piazza at lpiazza@hobartymca.org to complete the required document. If the status of the child's medication changes please, inform us immediately.
-Select One-YesNo
If you have additional questions or concerns please contact us at 219-942-2183 or info@hobartymca.org