One Hope Tulsa Summer Camp at the Rose Bowl

Camp Information

Si necesita ayuda para completar este formulario, envie un mensaje al (918-417-2624).

Please select each week that your student will attend camp.

After Project 61 week, the camp structure will remain the same from week to week, but each week will have a different theme and field trip like the zoo, Gathering Place, swimming pool, Aim High Academy Gymnastics, etc.

*Note the first week of summer camp, Project 61, has a unique schedule:Tuesday - Friday, 10:30 AM - 2:30 PM. Students will be fed lunch during Project 61 Week.*

June 3rd - June 7th (T - F), 10:30 AM - 2:30 PM - Project 61 Sports & Arts Camp Yes, my student will attend

June 9th-12th (M - TH), 1:30 PM - 4:30 PM - Nature & STEM Week Yes, my student will attend

June 16th - 18th (M - W), 1:30 PM - 4:30 PM - Music Week Yes, my student will attend

June 23rd - June 26th (M-TH), 1:30 PM - 4:30 PM - Animal Week Yes, my student will attend

June 30th - July 3rd (M-TH), 1:30 PM - 4:30 PM - Water Week Yes, my student will attend

July 7th - July 10th (M- TH), 1:30 PM - 4:30 PM - Art Week Yes, my student will attend

July 14th - July 17th (M - TH), 1:30 PM - 4:30 PM - Sports Week Yes, my student will attend

Student Information

Name

Gender

Male Female Prefer not to say

Birthdate

Which races or ethnicities best describe your student?

White/Caucasian Black/African American Hispanic/Latino Native American Asian/ Pacific Islander Other Prefer not to say

Please list any of the following: current medications, medication allergies, food allergies, or chronic health conditions.

Is your student enrolled in SoonerCare or Medicaid?

Yes No Other Uninsured Prefer not to say

Other

Education

Other

What are your student's strengths? What do they especially enjoy doing?

Does your student have any behavioral challenges, learning disabilities, etc?

Has your family or student had any recent losses we should be aware of?

Does the student have an IEP or 504 plan?

Yes No

If yes, please explain what the IEP is for and what accommodations are included in the IEP or 504 plan.

Students must be toilet trained to participate.

Yes, the student is toilet trained. No, the student is not toilet trained.

The following information will help us better serve your student and provide us with helpful data for grant funding. Your answer to this question will not affect your student's eligibility for this program.

Was your student suspended from school at any point during the 2024- 2025 school year?

Yes No Prefer not to say

Has your student ever been involved in the juvenile or criminal justice system (e.g., been arrested, charged, or placed on probation)?

Yes No Prefer not to say

Contact

Student's Address

Student lives with (choose all that apply)

Mother Father Grandma Grandpa Other relative(s) Other non-related adult(s) Foster parent(s)

Does student have siblings in the same household who will also be attending the program?

Yes No

Names of siblings attending the program:

Parent/ Guardian Information

Parent/ Guardian Name

Are you the parent or legal guardian of this student?

Yes No

Parent/ Guardian Primary Phone

Can we text information about the program to this number?

Yes Please use another number Please email

Parent/ Guardian Primary Email

This address will receive a confirmation email

Parent/ Guardian Address (if different from student's)

Parent/ Guardian 2 Name

Parent/ Guardian 2 Primary Phone

Parent/ Guardian 2 Email

This address will receive a confirmation email

Parent/ Guardian 2 Address (if different from student's)

Emergency Contact

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship to Student

Emergency Contact 2 Name

Emergency Contact 2 Phone

Emergency Contact 2 Relationship to Student

Transportation Information

We offer limited transportation to and from the Mitchell/ McKinley neighborhood. Pick-up/ Drop-off will be at 1:10 and 4:45 at the southeast corner of N. 73rd E. Ave and E. Latimer Pl.

Project 61 Week will offer more transportation options. Text 918-954-4147 for more information about getting your child to and from camp.

My student's transportation plan:

My student will ride the Mitchell/ McKinley neighborhood Van My student will be dropped off/ picked up My student will walk

Please list the names of anyone you authorize to pick up student. Parents/guardians and emergency contacts listed on this form may always pick-up students. Anyone picking up a student may be asked to show photo ID.

Please list the names of anyone who is NOT authorized by you to pick-up student.

Does your student have permission to walk home from the Rose Bowl? Note: if a student wishes to walk home early, director must make contact with student's parent.

Yes No

Releases and Late Policy

RELEASE OF LIABILITY: I, parent/guardian of the above-mentioned student, give my permission for him/her to participate in One Hope Summer Programs and I release the One Hope staff and volunteers from liability in the case of any kind of injury or harm that could occur during or due to my child's participation. I authorize the One Hope staff and volunteers to give my child emergency medical care and to transport him/her to and from places where such care can be provided and to authorize such care as they deem necessary. I also give permission for my child to be transported to and from One Hope's programs including summer camp and to and from events, activities, and field trips associated with One Hope, formal or informal. Further, I agree to abide by the policies of One Hope in relationship to Summer Camp and other One Hope events and activities.

Do you consent to the above statement?

Yes, I understand and give my consent.

MEDIA RELEASE: I also give my consent for One Hope staff or persons given permission by One Hope staff to use photos, videos, stories, and/or audiotape that feature or include my child and to use work done by my child as well as my child"s first name for the purpose of publicizing and promoting One Hope Tulsa. I understand that these images, text, or recordings maybe be published in newspapers, magazines, or on the internet, may be broadcast on television or radio, may be utilized in One Hope fund raising efforts and/or may be presented in One Hope information or promotional materials or presentations or used however One Hope sees fit.

Do you consent to the above media release?

Yes, I give my full consent to the above media release. I give consent for my student's photos and videos to be used ONLY INTERNALLY, such as printing photos to be hung in the classroom. I do not consent to their photo being shared on social media.

Late Pick-Up Policy

Students must be picked up from the Rose Bowl between 4:20-4:45 pm

We do not offer transportation after summer camp apart from our predetermined routes.

ANY PARENT/ GUARDIAN WHO WILL BE LATE MUST CALL.
We understand that unavoidable circumstances come up. Our goal is to support you and your child to the best of our ability. In the event that you will be late, we ask that you communicate with us as early as possible.

If no call was received prior to 4:00 p.m., the late fee will be assessed.

If a parent is late picking up their child a second time in a summer, regardless of a phone call, late fee charges will apply and must be paid within a one-week period. If the fees are not paid, the child will be suspended until the fees are paid.

If a parent is late picking up their child a third time, in addition to the fee being charged, we will set a meeting with the parent/guardian to discuss how we can move forward.

Late Fee Schedule:

4:45-5:00 $10.00
5:00-5:15 $25.00

Do you agree to the late policy?

Yes No

Note: filling out this registration does not guarantee your student's participation in our summer program. If their age group is full, your student will be placed on our waitlist.

One Hope Tulsa Summer Camp at the Rose Bowl

Description

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