DREAM Summer Enrollment Form

Please complete the following summer enrollment form for youth who are new to DREAM.
If a child is already enrolled in DREAM, please update their information and upload forms directly to their Salesforce profile.
Participant Information
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Parent/Guardian Information (1)
Preferred method of contact for updates on daily schedules and programs.

Parent/Guardian Information (2)
Preferred method of contact for updates on daily schedules and programs.
Parent/Guardian Signature: *
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Emergency Contact Information (different from parent/guardian)
Person 1
Ok to Text?


Person 2
Ok to Text?
These people can pick up/ drop off/ accept my child:
 YesNo
Emergency Contact #1
Emergency Contact #2
Additional people who can pick up/ drop off/ accept child:
 Full Name (for additional individuals)Relationship to YouthPhone Number
#1
#2
Media Release:
I give permission to use any pictures, images or likeness taken of my child during participation at camp by DREAM in connection with any publication, program or any and all media, including the DREAM Program, Inc. website, and DREAM’s authorized social media and marketing materials.

Parent/Guardian Signature:
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Insurance Release:
I understand the camp fees do not include health and accident insurance, and I will be responsible for any and all charges incurred for prompt medical treatment.

Parent/Guardian Signature: *
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Release Waiver:
In consideration of my child’s participation in The DREAM Program’s summer programming from June 15th, 2020 – August 14th, 2020, I hereby agree on behalf of myself, my heirs, legates, executors, administrators, and personal representatives, to release and hold harmless all chaperones and mentors, The DREAM Program, Inc., and any and all other persons and organizations assisting The DREAM Program, Inc., from liability for any injury to my child, to my child’s property and any and all claims in any manner arising from or associated with my child’s participation whether the liability, loss or damage is caused in whole or in part by their failure to use reasonable care in their activities associated with The DREAM Program, Inc.  I understand that in case of emergency, The DREAM Program’s staff and all other chaperones and mentors have my total permission to use their best judgment in matters of treatment and to have my child treated accordingly.


Parent/Guardian Signature: *
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Emergency Authorization:
I hereby give permission to the medical personnel selected by DREAM  to order x-rays, routine tests, and treatment for my child. In the event that I cannot be reached in an emergency, I also hereby permit the physician selected by DREAM to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for my child as named above. I also give permission for routine medical care for my child by the camp. This form may be photocopied for use off DREAM property.
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All Field Trip Permission:
I hereby give permission for my child to attend all local and special event field trips organized and supervised by DREAM Staff.  I understand that prior to any field trips parents/guardians will be informed ahead of time of the date, location and duration of such trips.
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Local Field Trip Permission:
I hereby give permission for my child to attend only all local field activities under the supervision of DREAM staff.  I understand “local” to mean walking distance from DREAM’s established meeting point within my child’s community/neighborhood.
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The DREAM Program operates with a core value of inclusion, and strives to be supportive of all participants regardless of their race, color, sex, sexual orientation, gender identity, religion, disability, age, veteran status, ancestry, or national or ethnic origin.