If you require assistance with our online registration, please contact our office at 610.489.2191. Camp Sign up Step 1 of 6 0% CAMPER INFORMATIONPlease fill in the camper's information.Camper First Name*Camper Last Name*Camper Gender*MaleFemaleAge as of 7/1/2017*Date of Birth* Grade Completed (2017)*Pre-schoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeSchool Attending*Camper T-Shirt*Every camper gets a FREE Hideaway Day Camp T-shirt. Please indicate your camper's size.Youth SYouth MYouth LAdult SAdult MAdult LIf possible, please group my camper with: Mailing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code YOUR INFORMATIONPlease fill in the parent or guardian information.Primary Parent or Guardian Name*Relationship to Camper*Primary Phone*Secondary PhoneSecondary Parent or Guardian NameRelationship to Camper (secondary)Primary PhoneSecondary PhoneEmail*Used for correspondence My child lives with both parents*YesNoIf No, my child lives with:* RATES1 - 3 weeks: $460/week (NO transportation) The following prices includes transportation: 4 weeks: $1840 5 weeks: $2250 6 weeks: $2700 7 weeks: $3080 8 weeks: $3520 Weekly Sibling Discounts: Second Camper $15 discount, Third Camper $20 discount, Fourth Camper $25 discount *Fourth of July Week Discount: $50ENROLLMENTCAMPER WEEKS:*Choose 1-8 weeks. Weeks do not need to be consecutive. (4 week minimum required for van transportation) Please check ALL weeks attending: *$50 discounted week June 19 June 26 July 3 July 10 July 17 July 24 July 31 August 7 EQUESTRIAN PROGRAMThis is an optional activity. All lessons are billed at $30/lesson. Please indicate the number of lessons (1-5) below that you would like your camper to have. Number of lessons may vary week-to-week. Lesson weeks should correspond to camper weeks. There is a discount of $30/week (one free lesson) for all who are registered to ride 5x/week. If you will not be participating, you can leave the field blank.June 19Please enter a value between 1 and 5.June 26Please enter a value between 1 and 5.July 3Please enter a value between 1 and 5.July 10Please enter a value between 1 and 5.July 17Please enter a value between 1 and 5.July 24Please enter a value between 1 and 5.July 31Please enter a value between 1 and 5.August 7Please enter a value between 1 and 5.Riding ExperienceHas your camper had any previous riding experience? If so, please explain...Riding Agreement*I give permission for my child to participate in the Hideaway Day Camp Riding Program. I release HDC and any of its representatives from any claim or demand which he/she may have by reason of these activities. Make-up lessons are available, depending upon availability. Hideaway Day Camp will not be responsible for reimbursing lessons if a camper is unprepared. You assume the risk of equine activities pursuant to Pennsylvania Law ~ Pennsylvania Equine Council. Please read the section entitled EQUESTRIAN PROGRAM in the Camper Handbook for additional information about the program, including the specific items required to have your camper ride. I Agree PIZZA ORDEREvery Monday is Pizza Monday! Campers may sign up to receive two slices of pizza, a choice of potato chips, pretzels or applesauce, and Gatorade for each Monday that they are attending.Would you like to participate in Pizza Mondays?*Cost is $5 per week.YesNo TRANSPORTATION INFORMATIONTransportation*If you would like transportation, a 4-week minimum enrollment is required. If you will be providing your own transportation, there is a $25/week/camper discount if the camper is enrolled for 4 weeks or more. Would you like us to provide van transportation, or will you provide your own?VanOwnIf you have chosen Hideaway to provide transportation for your camper(s), please choose one of the following:Both AM and PMAM OnlyPM OnlyAddress for Transportation Pick-up and/or Drop-off:Depending on the location of your home, pick-up/drop-off may be at the camper's HOME or at a CENTRAL LOCATION. Transportation is limited to one address. Transportation MUST be to and from the same address. Same as previous Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Closest street intersection or development name:BEFORE AND AFTER-CARE INFORMATIONPayment is due DAILY (cash, credit card or check accepted) when camper is dropped off and/or picked up in the afternoon. Parents may also prepay if they wish. Before/After Care charges are not automatically billed by HDC and will not be reflected in your regular statement.BEFORE AND AFTER-CARE PROGRAM: Regular Camp Day Hours are 9:00 AM to 3:30 PMCampers may arrive anytime AFTER 8:30 AM and incur NO Before-Care charges and picked up BEFORE 4:00 PM and incur NO After-Care charges. The cost for Before-Care and/or After-Care stay is $6/hour (Before-Care Hours: 8:00 - 8:30 AM, After-Care Hours: 4:00 - 5:00 PM) We will be transporting our camper(s) to and from camp and would like to take advantage of the following: Both Before and After-Care ($9/day) Before-Care ($3/day) After-Care ($3 - $6/day) ADDITIONAL PICK-UP LISTAdditional Pick-Up Information:Please list anyone other than parents/guardians who are permitted to pick up your camper(s). Please also list the person's relationship to the camper(s), eg. family friend, aunt, babysitter, etc. HIDEAWAY DAY CAMP 2017 POLICIESTERMS AND CONDITIONS*There is limited enrollment. Campers are accepted on a first-come, first-serve basis. We cannot hold a spot for any camper without a completed application and deposit. Should your application be received after enrollment closes, you will be notified, and placed on a waiting list if you desire; otherwise, your deposit will be returned. Full payment is required before we will add weeks/extend your camper's stay after the camp season has begun. The Camp is not responsible for the camper's equipment or personal belongings, while in transit or at camp, if lost or damaged by fire, theft, or otherwise. The Camp will make every effort to provide proper supervision so that losses will be at a minimum. Final group and transportation arrangements will be made when all tuitions are paid in full. Hideaway reserves the right to deny van transportation due to the pick up/drop off location of camper. Please call our office to check the availability of transportation in your area before sending in your completed application. It is agreed that the transportation service can only apply to the same address both AM and PM throughout the season with no exceptions. Hideaway cannot pick-up or deliver to different addresses. Camp cannot guarantee a particular vehicle of transport nor guarantee a pick-up or drop off time. Camp pledges to transport all children in the safest, most efficient way possible. I Agree CANCELATION/REFUND POLICY* If a cancelation occurs in writing before April 1st all monies, including deposit, shall be returned. If a cancelation occurs after April 1st and before May 1st, all monies except the original deposit shall be returned. NO REIMBURSEMENTS WILL BE MADE for any canceled weeks/days after May 1st. There is no allowance nor refund for any absences, late arrival or early withdrawal of campers. This is STRICTLY enforced. I Agree RELEASE OF CLAIMS & MEDICAL AUTHORIZATION*A completed medical form must be completed before a camper may begin. All medical forms for the camp-season will be shredded and destroyed upon the close of the session. We will not retain any obsolete camper medical information or files. As the parent or guardian of a camper, intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release Hideaway Day Camp, their officers, representative, successor, and/or assigns for any and all damages which may be sustained or suffered by me in connection with my association with the HDC program, or any activities related thereto, including without limitation, my traveling to or participating in and returning from any activity associated with the program. Parent or guardian agrees that the camper is in sound physical and mental health and fully able to participate in all camp activities without the need of individual or specialized attention, medical or otherwise. We reserve the right to deny or cancel enrollment if the camper's health, physical or mental, interferes with any camp activity or is not in the best interest of the camp or the other campers. The Directors reserve the right to deny, cancel, sever or suspend a child's enrollment if deemed his/her behavior is not in the best interest of the camper or the Camp. Fees not refundable. Please select the SIGN UP tab and the DOWNLOAD FORMS tab to print out a Camper Health History Form. All completed Camper Health History Forms must be mailed. Emailed forms will not be accepted. I Agree PHOTO AND VIDEO RELEASE*I grant permission for my child or ward to be photographed, videotaped and/or interviewed during the course of our season by HDC or any of its authorized agents, and consent for the publication, broadcast, or other use of the camper’s images and/or words for the purposes of promoting Hideaway Day Camp. In addition, I, intending to be legally bound for myself, my heirs, executors and administrators, release Hideaway Day Camp, or any parties acting on their behalf and with their approval, from liability for such uses of my child’s or ward’s images and/or words. I Agree HANDBOOK AFFIRMATION*I have read the Camper and Parent Handbook and I understand what is expected of me as a member of Hideaway Day Camp. I understand and have discussed with my child(ren) that s/he will be expected to conduct her/himself in a disciplined manner while enrolled in camp. I grant HDC permission to act on my behalf in safeguarding my camper(s) health and safety. In the event that I cannot be contacted in an emergency, I grant Hideaway Day Camp permission to give my child immediate treatment and/or take my child to a hospital emergency room. I agree that Hideaway Day Camp is not responsible for accidents, injuries, and/or medical or dental expenses arising from my child's participation and covenant not to sue and waive, release, and discharge Hideaway and anyone working on their behalf from any and all claims of liability or any expenses. Please select the SIGN UP tab and the DOWNLOAD FORMS tab to find our Camper Handbook. I Agree PAYMENTA $300 deposit is required to complete registration. Once your online application is processed by the office, you will receive a confirmation email. All balances are due May 1st. If applying after May 1st, balance is due once registration confirmation is received. No refunds or reimbursements after May 1st. If enrollment is canceled after April 1st and before May 1st, all monies except the $300 deposit is returned.Deposit* Price: $300.00 Billing Address* Same as Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe This page is unsecured. 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