2019 A Taste of Giving
Thursday, 6:30 pm
Thursday, 7:00 pm
Green Light Initiative
Camp Happy Times
2101 Millburn Avenue
Maplewood, NJ 07040
Fax to: 973-761-6792 Attn: Camp Happy Times
Scan and Email to: email@example.com
Questions? email us at firstname.lastname@example.org
All medical information is maintained under the supervision of the Infirmary Medical Supervisor,
Camp Happy Times, and is protected by Federal Confidentiality Laws.
Click here to download and send in the medical application.
The medical application must be printed from this website and brought to your doctor for completion.
*You must include a photocopy of the front and back of the camper’s current
health insurance card*
Section 1: (Personality)
Section 2: (Camp/Cabin Specific)
Section 3: (Medical)
In a continuing effort to offer campers the best week possible with the most memorable outcomes, rules for camper behavior should be understood and agreed upon by the Camper and Parent/Guardian before attending Camp Happy Times. While situations are not anticipated, this code is simply a way to provide a safeguard for the Camp as well as the participants. Please discuss with your child the following rules and the importance of adhering to them during their attendance at Camp Happy Times (CHT).
The Camper and Parent/Guardian must sign this agreement in order to for the applicant to attend. Campers are expected to abide by the following codes
Unacceptable behavior during Camp Happy Times (as defined within this Code or through an administrative review process) may result in the following consequences (not necessarily in this order):
NOTE: Any conduct not specifically covered by this code of conduct, but deemed inappropriate by those responsible for Camp Happy Times will be viewed as a violation and appropriate action will be taken. If an infraction occurs, the Camp Director will provide appropriate communication to parent/guardian.
As a participant at Camp Happy Times, I have read and understood the above “Code of Conduct” and will abide by the expectations described in the Code of Conduct. I understand that if I act inappropriately, I will have to accept responsibility for my actions that may result in the consequences listed above.
As parent/guardian, I have discussed and reviewed the above “Code of Conduct” with my child. I understand that failure to abide by the “Code of Conduct” may result in consequences listed above. In the event of that my child is discharged from Camp Happy Times, I assume the responsibility of transporting my child home on the day of such action.
I understand and agree that Camp Happy Times, The Valerie Fund and all of their agents, representatives and employees (paid or volunteer) accept no responsibility for the loss, damage or theft of my child’s property.
Should either parents or guardians, during the 2018 Camp Happy Times Session, leave my/our place of residence; I will advise the Camp Administration where I/We can be contacted in the event of an emergency.
I understand and agree that certain activities at Camp Happy Times have an increased risk of injury. I understand and agree to release, waive, indemnify, defend and hold harmless Camp Happy Times, The Valerie Fund and all of their agents, representatives and employees (paid or volunteer) from any and all injuries, losses, claims, cost, expenses and/or damages.
In the event of a medical or surgical emergency, I hereby authorize the Licensed Medical Staff at Camp Happy Times to render to my child or arrange for my child to receive any and all treatment deemed advisable by them and to be rendered under the supervision of medical personnel. I understand that I am responsible for obtaining insurance authorization or referral if needed for such treatment and any cost incurred for such that any existing insurance may not cover. I also understand that I will be contacted in the event of an emergency.
All information is correct so far as I know and the child/camper herein described has permission to engage in all prescribed camp activities, except as noted by me and the examining physician. By signing below, I hereby understand and agree with all of the terms listed above.
I hereby authorize The Valerie Fund’s Camp Happy Times to take my child to any scheduled off-site trip. This authorization includes all travel to and from, and attendance at an off-site event. Parent grants this authorization knowingly and voluntarily and fully recognizing the potential risks and hazards (to both persons and property) that may be associated with travel to and from, and attendance at an off-site event. In consideration for The Valerie Fund agreeing to take Camper to an off-site event, Parent knowingly and voluntarily releases and discharges The Valerie Fund, its officers, directors, employees, volunteers, trustees, administrators and agents (collectively “Releasees”), from any and all liability, demands, causes of action, legal proceedings, damages (including, but not limited to, damage or injury to persons or property) and claims of every kind, nature and description whatsoever, whether known or unknown, including attorneys’ fees and costs related thereto (collectively “Claims”), which against Releasees, its successors and assigns, Parent, on behalf of Parent’s self, Parent’s spouse, children, guardians, heirs, executors, administrators, predecessors, successors and assigns (“Releasors”) has, had or may have, relating to any off-site trip. Parent further agrees to defend, indemnify and hold the Releasees harmless from and against any and all Claims arising out of or related to the acts or omissions or Camper in connection with travel to and from, and attendance at any off-site trip.
The Valerie Fund
2101 Millburn Avenue
Maplewood, NJ 07040
973-761-0422 :: Phone
973-761-6792 :: Fax
©2018 The Valerie Fund. All Rights Reserved. | We are a 501(c)(3) charity