Camper Information Camper First Name*
Camper Last Name*
Camper Gender* Please Choose Male Female
Camper Phone Number*
Camper Email*
Camper Date of Birth* Please Note: Camper must be at least 13 years old, or no older than 17 years old on the first day of camp.
How old is the Camper?* School Grade* What grade will the camper be entering in the fall?
Please Choose 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
What is the name of the middle or high school the camper attends?*
Camper Type* Please Choose Return Camper First Time Camper
Camper T-Shirt Size* Please Choose Small Medium Large X-Large XX-Large
Please Note: all t-shirts are adult sizes
Cabin Mate Request
Please enter the name of ONE person you would like to request as a cabin mate. We will do our best to meet your request, but there are no guarantees. You will not be able to change this request once it is entered.
Camper Food Allergies The Camp kitchen is completely nut free. Please indicate if there are any other food allergies we should be aware of.
Social Media Stay connected! Follow us at @campspinoff on Instagram, Facebook, Twitter or Snapchat. Feel free to provide your social media handles below
Instagram
Facebook
Twitter
Snapchat
How did you hear about Camp Spin Off?* Please Choose Google Search Facebook Convention/Promotional Event Article or Blog Post Scratch DJ Academy Friend or Previous Camper
Parent or Guardian Information Parent First Name*
Parent Last Name*
Parent Cell Phone Number*
Parent Work Phone Number*
Parent Email*
Social Media Stay connected! Follow us at @campspinoff on Instagram, Facebook, Twitter or Snapchat. Feel free to provide your social media handles below
Instagram
Facebook
Twitter
Snapchat
Address*
Emergency Contact Information Please provide a contact other than a parent in case of an emergency.
Emergency Contact Name*
Emergency Contact Cell Phone Number*
Relationship to Camper
Pickup Authorization Please provide the names of anyone other than the parent/guardian that are authorized to pick up or sign out the camper
Pickup Authorization Names Please add full names and 1 per line.
Insurance Information The following information will be submitted to our campsite host, Camp Nawakwa.
In accordance with the American Camping Association and the Laws of the State of California, we must have a Health History/Medical Consent Form completed and signed by the parent or legal guardian for each camper under age 18 attending Camp Nawakwa. Your camper cannot begin the program unless this form is completed and the required signatures are provided. Please be aware that Camp Nawakwa does NOT provide medical or hospital insurance coverage. Camp Nawakwa REQUIRES this information in order to provide appropriate medical care in the event of injury and/or illness while at camp. Camp Spin Off and Camp Nawakwa are committed to protecting the confidentiality of this information.
Insurance Carrier*
Insurance Policy Number*
First Name of Responsible Party*
Last Name of Responsible Party*
Relationship to Camper*
Address*
First Name of Family Physician*
Last Name of Family Physician*
Family Physician Phone Number*
First Name of Family Dentist/Orthodontist
Last Name of Family Dentist/Orthodontist
Family Dentist/Orthodontist Phone Number
Camper Medical Conditions & Dietary Needs Camper Special Dietary Needs* Please Choose None Vegitarian Vegan
Medical Conditions List all medical conditions: physical, emotional, behavioral disorders, and learning disabilities.
Allergies Please list ALL Drug, Food, Insect/Plant or dietary restrictions
Medications List Medications Camper will require while at camp and reason for taking the medicine. Please include over-the-counter and/or prescriptions.
Chronic Conditions Please select any of the following CHRONIC conditions your child might have. For any of the conditions below, a SPECIAL MEDICAL NEEDS PROCEDURE AUTHORIZATION FORM MUST BE OBTAINED AND SUBMITTED AT LEAST 2 WEEKS PRIOR TO CAMP DATES. If a child with special needs comes to Forest Home without written authorization from a doctor, the group or party may be asked to return the child to his/her home. Please contact
[email protected] to obtain a SPECIAL MEDICAL NEEDS form.
General Health History REQUIRED: Select "Yes" or "No" for each statement.
Explain “Yes” answers below.
Has/does the camper:
Ever been hospitalized?* Please Choose No Yes
Ever had surgery?* Please Choose No Yes
Recurrent/Chronic Illness?* Please Choose No Yes
Had a recent infectious disease?* Please Choose No Yes
Had a recent injury?* Please Choose No Yes
Had asthma/wheezing/shortness of breath?* Please Choose No Yes
Have diabetes?* Please Choose No Yes
Had seizures?* Please Choose No Yes
Wear glasses, contacts, or protective eye wear?* Please Choose No Yes
Had fainting or dizziness?* Please Choose No Yes
Passed out/had chest pain during exercise?* Please Choose No Yes
Had mononucleosis ("mono") during the past 12 months?* Please Choose No Yes
If female, have problems with periods/menstruation?* Please Choose No Yes
Have problems with falling asleep/sleepwalking?* Please Choose No Yes
Ever had back/joint problems?* Please Choose No Yes
Have a history of bedwetting?* Please Choose No Yes
Have problems with diarrhea/constipation?* Please Choose No Yes
Have any skin problems?* Please Choose No Yes
Traveled outside the country in the past 9 months?* Please Choose No Yes
If you answered "Yes" to any of the above... Please explain “Yes” answers in the space below, noting the number of the questions. For travel outside the country, please name countries visited and dates of travel.
Camper Vaccination Records The State of California and County law require an accurate record of the camper's current immunization status. All campers must provide documentation of the administration of at least the first doses of MMR (Measles, Mumps, Rubella), Tdap/dtap (Tetanus, Diphtheria, Pertussis), and Meningitis prior to attending/participating in Camp Spin Off. Individuals that do not provide immunization records or do not have up-to-date vaccinations will not be allowed to attend Camp Spin Off.
Polio (OPV or IPV) Date
DTP/DTap/DT/TD Date:
(Diphtheria, Tetanus and Acellular Pertussis or Tetanus and Diptheria only)
MMR Date:
(Measles, Mumps, Rubella)
Hepatitis B Date:
Varicella (Chicken Pox) Date:
Immunizations before camp If your child will receive a booster or any of the above required immunizations prior to camp, please check the box below.
Camper Vaccination History By checking below you are declaring that your attendee is in compliance with California State law, being up to date with all current immunizations required and can provide documentation of the administration of at least the first doses of MMR (Measles, Mumps, Rubella), Tdap/dtap (Tetanus, Diphtheria, Pertussis), and Meningitis prior to attending/participating in Camp Spin Off.
Immunization Records If your child's immunization records are up to date, please take a photo or scan a copy of the record and upload here in a jpeg, png or pdf format.
Medical Consent Authorization By signing this form I give my informed consent to the First Aid personnel assigned by Camp Nawakwa. who are certified in a minimum of CPR and First Aid by a nationally recognized provider to provide basic First Aid and comfort measures through standardized camp treatment procedures which includes the use of over-the-counter medications. I understand that it is my responsibility to make arrangements for a camper with greater health care needs than the First Aid personnel can provide within their individual certifications, licenses and scopes of practice. I authorize Camp Nawakwa. to arrange for or provide any necessary related transportation to the nearest medical facility for urgent or emergency medical treatment if indicated, and I do assume all responsibility for payment for such treatment. I hereby give permission to the physician selected by Camp Nawakwa. to secure and administer any and all medical treatment deemed necessary for my child, including hospitalization. This completed form may be photocopied for trips away from Camp Nawakwa. properties.
I authorize the use of the following generic, over-the-counter medications as directed by the labels provided by the manufacturer for my child: analgesics, decongestants, antihistamines, cough suppressant, throat lozenges, epi-pen, antacid, antibiotic ointment, hydrocortisone cream, burn cream, petroleum jelly, chapped skin/lip treatment, antiseptic skin and wound cleansers, glucose, laxatives, electrolyte replacement fluids. Below I will list any exceptions. I understand that these are stocked and dispensed by the First Aid personnel free of charge as needed for the comfort of my child.
I have requested Camp Nawakwa to allow my child to participate in any and all activities that may include but are not limited to those outlined in the camp brochure. As a condition of receiving this benefit, I do hereby agree to the following: I understand that my child’s participation in these activities can expose him/her to dangers both from known and unanticipated risks. Acknowledging that such risks exist, I on behalf of myself, my child and any other party who may have the right to assert any rights for or on behalf of my child, do hereby forever release and discharge, indemnify and hold harmless Camp Nawakwa, its affiliates, officers, directors, agents, employees, insurers, successors in interest, attorneys, or any other person or persons associated with any or all of them who might be liable (the “Released Parties”) from and against any and all claims, causes of action, actions, suits, demands, losses, damages, expenses, costs or liability (collectively, “Losses”) arising from or in connection with my child’s participation in Camp Nawakwa camp and its activities, including Losses arising from the negligence of any of the Released Parties, whether such Losses arise in connection with bodily injury (including death), property damage or otherwise (collectively, the “Released Claims”). The Released Claims include Losses arising out of any condition of the premises at which the camp activities are held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity, whether planned or unplanned. In the event that child abuse is reported while your camper is at Camp Nawakwa, we may fully cooperate with Child Protective Services and Law Enforcement for the best interest of the child.
I further understand and acknowledge that I make this release in full accord and satisfaction of and in compromise of any and all Released Claims. I represent and acknowledge that I have read and understand this form and the release granted above and warrant that all statements made herein are true to the best of my knowledge. I have read and understand this entire form and by signing below agree to the terms herein.
Exceptions Please list any generic, over-the-counter medications (as listed above) that you do not approve of being administered to your son/daughter
Parent or Guardian Digital Signature*
Please type your full legal name
Parent or Guardians Digital Signature Confirmation for Medical By typing my name above and checking the box the below, I am digitally signing this document.
MEDIA CONSENT I hereby give my full consent to Camp Spin Off and it’s affiliates to record (video, photograph, audio recording or other) my child's participation in any programs or events associated with Camp Spin Off. Further, I hereby transfer and assign to Camp Spin Off the exclusive rights to use and to authorize others to use said images, video, photography, audio recordings or other, for promotional and educational use in the future. I understand that my child’s image, voice or video recording may be used, but my name or personal information will never be shared publicly without additional, separate consent.
Parent or Guardian Digital Signature for Media Parent or Guardian Name:
Parent or Guardians Digital Signature Confirmation for Media Release: By typing my name above and checking the box the below, I am digitally signing this document.
Camp Spin Off Zero Tolerance Policy & Code of Conduct Camp Spin Off practices a “zero tolerance” policy when it comes to alcohol, illegal drugs, tobacco products,
misuse of prescription drugs, weapons and sexual misconduct. We reserve the right to dismiss any camper whose action, behavior or attitude, in our judgment, is contrary to the best interest of the camp. If Camp Spin Off or Camp Nawakwa staff has any suspicions of drug use, all campers will be subject to a bag search. Campers in violation of this policy will be sent home at their own expense. No refunds will be granted. Please keep this in mind while packing for camp.
Parent or Guardian Digital Signature for Zero Tolerance Policy & Code of Conduct* Parent or Guardian Name:
Parent or Guardians Digital Signature Confirmation for Zero Tolerance Policy & Code of Conduct By typing my name above and checking the box the below, I am digitally signing this document.
Camper Digital Signature for Zero Tolerance Policy & Code of Conduct* Camper Name:
Camper Digital Signature Confirmation for Zero Tolerance Policy & Code of Conduct* By typing my name above and checking the box the below, I am digitally signing this document.
Parental Registration Permissions I have requested Camp Spin Off and Camp Nawakwa. to allow my child to participate in any and all activities that may include but are not limited to those outlined on the Camp Spin Off website. As a condition of receiving this benefit, I do hereby agree to the following: I understand that my child's participation in these activities can expose him/her to dangers both from known and unanticipated risks. Acknowledging that such risks exist, I on behalf of myself, my child and any other party who may have the right to assert any rights for or on behalf of my child, do hereby forever release and discharge, indemnify and hold harmless Camp Spin Off and Camp Nawakwa, its affiliates, officers, directors, agents, employees, insurers, successors in interest, attorneys, or any other person or persons associated with any or all of them who might be liable (the "Released Parties") from and against any and all claims, causes of action, actions, suits, demands, losses, damages, expenses, costs or liability (collectively, "Losses") arising from or in connection with my child's participation in Camp Spin Off/Camp Nawakwa's camp and its activities, including Losses arising from the negligence of any of the Released Parties, whether such Losses arise in connection with bodily injury (including death), property damage or otherwise (collectively, the "Released Claims"). The Released Claims include Losses arising out of any condition of the premises at which the camp activities are held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity, whether planned or unplanned. In the event that child abuse is reported while your camper is at Camp Nawakwa, we may fully cooperate with Child Protective Services and Law Enforcement for the best interest of the child.
Parent or Guardian Digital Signature for Registration Permission:* Parent or Guardian Name:
Parent or Guardian Digital Signature for Registration Permission: By typing my name above and checking the box the below, I am digitally signing this document.
Release of Responsibility I, as the parent and/or guardian of the individual named in this form giving permission for his/her attendance at Camp Spin Off, located at Camp Nawakwa on the dates specified herein, except for willful misconduct or gross negligence of Camp Spin Off or Camp Nawakwa, its directors, officers, staff or any other persons connected therewith, agree to indemnify and hold Camp Spin Off or Camp Nawakwa, and each of the persons connected therewith, harmless for injury or damage to the person or property of said individual. All references to "attendee" or "camper" are deemed to be one and the same as "my child". I further understand and acknowledge that I make this release in full accord and satisfaction of and in compromise of any and all Released Claims. I represent and acknowledge that I have read and understand this form and the release granted above and warrant that all statements made herein are true to the best of my knowledge. I have read and understand this entire form and by signing below agree to the terms herein.
Parent or Guardian Digital Signature for Release of Responsibility* Parent or Guardian Name:
Parent or Guardian Digital Signature for Release of Responsibility* By typing my name above and checking the box the below, I am digitally signing this document.
Registration Payment Shuttle Reservations* Camp Spin Off provides an optional Free Shuttle service to/from Camp with (2) Pick-up/Drop-off Locations: Los Angeles International Airport (LAX) and To Be Determined LA Location. You will receive more information about the shuttle after you register. Please contact
[email protected] with any questions.
Payment Type* Registration Fee* There are only a total of 50 spots available.
Coupon Code Total
$0.00
Credit Card* Payment Plans Payment Plans are only available at the Standard Tuition Rate ($1499). Automatic payments can be billed on a monthly, twice-monthly or quarterly basis. The initial $100 minimum deposit is nonrefundable starts you on a payment plan. You may make a deposit amount greater than $100 if you wish. Please contact
[email protected] with any questions regarding the payment plans.
Payment Plan Options* Please select what type of automatic payment plan that you would like.
Payment Plan Terms* I would like to make a $100 minimum deposit and enter a payment plan for my son/daughter's tuition to Camp Spin Off. I understand that upon completing this registration form, I will be redirected to Rerun, a secure, third-party website to make my one-time $100 minimum deposit. Based on your selections above, you will be entered into a payment plan for your automatic payments. You will receive an email prior to your first automatic payment with a confirmation on the amount and frequency of your payments based on your selections above.
Phone
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