Camp Achieve Registration 2019 Forms
Camp Achieve Registration
Your child has been recommended to attend Camp Achieve, our extended school year program for classified students. For all students from preschool through grade 8, Camp Achieve starts on July 8th and ends on August 8th. There is no school on Fridays.
If your child is a preschooler, they will attend camp from 8:30 to 11:00 a.m., Monday through Thursday. All other children in kindergarten through grade 8 will attend from 8:30 to 1:00. Transportation is provided for all of our Camp Achievers.
It is now time to register your child for Camp Achieve. Below is the registration/health form for you to complete. Kindly return it to Chester Student Services, 250 Rt. 24, Dickerson School, Chester, N.J. 07930.
It is very important that you indicate whether or not your child will need transportation, so that we can plan accordingly. The registration form should be returned no later than May 1st, 2019. If you have any questions, please do not hesitate to call your child’s case manager or me at 908-879-6004.
Dr. Jeanette Krone
Dr. Jeanette Krone
Director of Student Services
REGISTRATION AND HEALTH INFORMATION
Student’s Last Name_________________First Name _____________
Current Age_______ Current Grade _____Birthdate__________
Parent’s Name: _________________________________
E-mail address: _________________Cell Phone #:_______________
Transportation ________ yes _________no
Please list two neighbors or nearby relatives who will assume temporary care for your child if you cannot be reached:
In case of a medical emergency, we will immediately call you and the Chester Rescue squad.
To ensure the health and safety of all students, our summer school nurse, needs the following information about your child.
PERMISSION FOR MEDICAL TREATMENT AND TRANSPORTATION TO THE HOSPITAL
I hereby give permission for my child to be transported by emergency vehicle to a nearby hospital and given whatever aid is necessary.
Signature of Parent/Guardian________________ Date: _____________
Please indicate below a person to call if you cannot be reached in the event of an emergency:
Name: ____________________ Phone #: _________________________
Allergies and/or special needs: __________________________________
Date of last tetanus booster: ___________
List any current medication your child is prescribed: _______________
Kindly indicate if your child will need this medication during Camp Achieve: ___yes __ no
(Please provide the nurse with the medication and a doctor's note on the first day of Camp Achieve.)