Once you complete and submit the online registration, you will receive a confirmation email within 48 hours. If your selected weeks are unavailable, you will be notified. If you require assistance, please contact our office at 610.489.2191. Step 1 of 6 0% CAMPER INFORMATIONPlease fill in the camper's information.Camper First Name*Camper Last Name*Camper Gender*MaleFemaleAge as of 7/1/2023*Our youngest campers must be 5 years of age by May 1st to attend.Date of Birth* Date Format: MM slash DD slash YYYY Grade Completed (2023)*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: $550/week (NO transportation) The following prices include transportation: 4 weeks: $550/week 5 weeks: $540/week 6 weeks: $530/week 7 weeks: $520/week 8 weeks: $510/week 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. A 4-week minimum is required for van/bus transportation (central location/bus stop only) and you will be notified if your transportation address is not within our serving area. Please select ALL weeks that apply: June 19 June 26 July 3* (Closed 7/4, $50 discount) July 10 July 17 July 24 July 31 August 7 PIZZA ORDEREvery Monday is Pizza Monday! Campers may sign up to receive two slices of pizza, a choice of snack, 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*Transportation is provided by camp van or school bus at a CENTRAL LOCATION. You will be notified of the location of your van/bus stop two weeks prior to the start of your camper's stay. 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:Transportation by camp van/bus will be at a CENTRAL LOCATION (close to your home, business address or other location). The following address will help us to determine that location which you will be notified of prior to the start of your camper's season. Transportation same as 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 If the above address is a Business address, please enter the name of the business.Closest street intersection or development name: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 2023 POLICIESTERMS AND CONDITIONS*HDC has a rolling enrollment. Enrollment, though limited, extends throughout our summer season. Campers are accepted on a first-come, first-serve basis. We cannot hold placement for any camper without a completed application and deposit. Should your application be received after the groups reach capacity, you will be notified, and placed on a waiting list; 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 March 1st all monies, including deposit, shall be returned. If a cancelation occurs after March 1st and before April 1st, all monies except the original deposit ($300) shall be returned. FULL PAYMENT IS DUE APRIL 1st NO REIMBURSEMENTS WILL BE MADE for any canceled weeks after April 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 required by HDC will be shredded and destroyed upon the close of the season. 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. 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 will read the Camper Handbook to understand what is expected of me as a member of Hideaway Day Camp. I understand and will discuss 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. The Camper Handbook will be made available upon registration. 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 April 1st. If applying after April 1st, balance is due once registration confirmation is received. No refunds or reimbursements after April 1st. If enrollment is canceled after March 1st and before April 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 SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini 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GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands NameThis field is for validation purposes and should be left unchanged.