POP Summer Camp – Most Powerful People

Camp P.O.P Enrollment Form (2023)

Step 1 of 3

APPLICATION INFORMATION

Applicant Type(Required)

Entry Term/Program (When would you like to start?)(Required)

Are you enrolling multiple children?(Required)

Yes (If yes, please complete info for all children below under "Camper Demographic". If you are enrolling more than 4 children please call/text 215.948.9417)

CAMPER DEMOGRAPHIC INFORMATION

Child #1 Name(Required)

First Last

Gender(Required)

Race/Ethnicity(Required)

Current Age(Required)

Date of Birth(Required)

School Grade Entering in the Fall(Required)

Name of School(Required)

Child #2 Name

First Last

Gender

Race/Ethnicity

Current Age

Date of Birth

School Grade Entering in the Fall

Name of School

Child # 3 Name

First Last

Gender

Race/Ethnicity

Current Age

Date of Birth

School Grade Entering in the Fall

Name of School

Child #4 Name

First Last

Gender

Race/Ethnicity

Current Age

Date of Birth

School Grade Entering in the Fall

Name of School

PARENT/GUARDIAN DEMOGRAPHIC INFORMATION

Name(Required)

First Last

Relationship to Camper(Required)

Email(Required)

Cell Phone(Required)

Other Phone

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you an active duty, reserve, or veteran member of the United States Military?(Required)

EMERGENCY CONTACT INFORMATION (other than parent/guardian, if applicable)

Emergency Contact # 1 Name(Required)

First Last

Relationship to Camper(Required)

Phone(Required)

Is the above-named person allowed to: (Check all that apply)(Required)

Caregiver

Emergency Contact

Authorized for Pick Up

Emergency Contact # 2 Name

First Last

Relationship to Camper

Phone

Is the above-named person allowed to: (Check all that apply)

Caregiver

Emergency Contact

Authorized for Pick Up

HEALTH INFORMATION

Are there any medical, behavioral, mental health, dietary restrictions, and/or special needs that's important to know (asthma, seizures, allergies, nosebleeds, ADHD, grief/trauma, oppositional defiance/conduct disorder, etc.)(Required)

PLEASE UPLOAD A COPY OF CAMPER'S MOST RECENT PHYSICAL/MEDICAL RECORDS (If enrolling multiple children, attach additional documents below)(Required)

Max. file size: 100 MB.

File

Max. file size: 100 MB.

File

Max. file size: 100 MB.

File

Max. file size: 100 MB.

CODE OF CONDUCT

The code of conduct for Power of Paint Art Academy & Management (POP Art Academy) programs defines expectations for all participants to ensure that all are safe and to reduce disciplinary problems. A disciplinary problem is defined as one in which a child is hampering the smooth flow of the program by either requiring constant one on one attention; is inflicting physical or emotional harm on other children; is physically or verbally abusing staff or is otherwise unable to conform to the rules and guidelines of the program.

Guidelines(Required)

1. Check in to the assigned program upon arrival to site; check out upon departure. 2. Do not bring valuables to the facilities. We are not responsible for loss or stolen items. 3. Vandalism of any sort is prohibited. 4. Participants must be respectful toward staff members and fellow students. We have a no-bullying culture at Power of Paint. Bystander behavior must also show respect for all. Respect the rights and privacy of others. If someone wants you to know something about them, they will tell you. Gossiping and talking behind people’s backs is unacceptable. Treat others kindly and expect the same from them. If you have a problem, let a staff person know. 5. Respect the personal dignity, opinions, and possessions of others. Understand that everyone is different. Your ideas might be different, but that does not make you right. If someone chooses not to share possessions with you, that is their decision. Do not play jokes on others. Take care not to hurt, upset, or embarrass anyone. Name-calling is not tolerated. 6. Participant's must be respectful of others’ property, including, but not limited to property of other students, campers, other participants, and all POP Art's business supplies, equipment, facilities and property. 7. Treat the employees—of places we visit, eat, or stay—with respect and use good manners. Do everything you can to make their job easier. 8. Stealing is prohibited. 9. Fighting or hitting of any sort is not tolerated. 10. Abusive or offensive language/behavior is not permitted. Participants must always use appropriate language. 11. Participants may not possess lighters/matches, knives, or other dangerous items. 12. Participants must help in cleaning up after themselves in all activities. 1. Code of Conduct 13. Never leave the P.O.P site or assigned group without permission from a P.O.P staff member. 14. Sneakers is recommended at all times; please note that clothing may get messy and may acquire stains based on activities. 15. Please do not bring outside food and/or beverages that may contain common allergens. We are a nut-free and shellfish free campus. 16. Be willing to share information related to the health, safety, and wellbeing of the group. Talking about something that you think we should know is not squealing/”snitching”; it’s making the learning environment safer and better for all. 17. Be aware of the daily schedule and be on time. 18. During transportation, stay seated with your seatbelt fastened, use your inside voice, and treat the bus driver respectfully. 19. Be aware of and abide by all program rules and if you are not sure of something, ask!

WAIVERS & LIABILITY

I certify that all information submitted in the enrollment process — including this application and any other supporting materials — is my own (or have legal right to share), factually true, and honestly presented, and that these documents will become the property of the organization to which I am applying and will not be returned to me (copies can be requested in writing for any records.) In place of your signature, please type your full legal name:(Required)

ADDITIONAL INFORMATION

Shirt Size (select one)(Required)

How did you hear about our program?(Required)

Have you previously engaged in any other program at Power of Paint (POP Art)?(Required)

Camp P.O.P Enrollment Form (2023)

APPLICATION INFORMATION

CAMPER DEMOGRAPHIC INFORMATION

PARENT/GUARDIAN DEMOGRAPHIC INFORMATION

EMERGENCY CONTACT INFORMATION (other than parent/guardian, if applicable)

HEALTH INFORMATION

CODE OF CONDUCT

WAIVERS & LIABILITY

ADDITIONAL INFORMATION

CONTACT DETAILS

PAYMENT