Scales Lake Park Day Camp is for ages
5—12.
Campers will need to bring their lunch everyday. We will
have a
Refrigerator available if needed.
Activities include swimming, swim lessons, crafts,
hiking, wiffleball, kickball, lots of walking and many more!
Childs Name:___________________________________________________________
Age:___________
Sex __M __ F
Birth date:______________
Address:_______________________________________________________________
______________________________________________________________________
Grade:______________ Home Phone:_________________
Day Camp Fees :
$80.00 per child per week.
$60.00 for each additional sibling per child per week.
If you sign up for more than one week take off $5.00 per week after the 1st
week.
Mother's Name:________________________________________________________
Employer: Name and Address: ____________________________________________
_______________________________ Work Phone:__________________________
Must pay $25.00 (non-refundable deposit) per week per child at sign up.
Balance due the Monday of start of camp. Any payments made after
Monday will be assessed a $10.00 late fee per child.
Father’s Name:_______________________________________________________
Employer: Name and Address:_____________________________________________
Mail or drop off form to: Scales Lake Park at 800 W Tennyson Road, PO Box
58, Boonville, IN 47601. Any questions please call 812-897-6200.
__________________________________Work Phone:_________________________
Please check the weeks you are registering for:
Marital Status:_______________________ Primary Guardian____________________
_____ June 7—11
_____ July 5—9
Person Responsible for Payment:___________________________________________
_____June 14—18
_____ July 12– 16
Emergency Contact:_______________________________ Phone:________________
_____June 21– 25
_____ July 19—23
Insurance Carrier Name: __________________Policy Number: _____________ _____
______ July 26—30
Medicine currently taking: ________________________________________________
_____June 28—July 2
_____ August 2—6
Allergies (food, medicine, latex, etc.) _______________________________________
Amount Enclosed: $___________________
Persons Authorized to pick up camper besides parents:
______________________________________________________________________
______________________________________________________________________
RELEASE
Scales Lake Park is committed to providing children an opportunity for full and equal
enjoyment of the camping experience. If your child appears to have any serious
behavioral problems or special circumstances involving physical, medical, or social
concerns, the Director should be notified of this now, so that reasonable modification
can be considered. Scales Lake Park recognizes that most children’s problems are
quite normal and correctable through a program of high expectations and positive
motivation. However, children with serious behavioral problems should have special
guidance concerning their readiness before going to camp. These problems should be
discussed with the Director and the advisability of accepting the child into the camp
program can be determined at this time. The director reserves the right to decline the
application of any child, or send home any child, who according to the Director’s
discretion is not a desirable associate for the other campers. If a camper is dismissed
due to behavioral/social issues, the tuition is not refundable.
By signing this application, it is understood that permission is hereby given to use
pictures in which my child as a camper may appear in the Camp brochure, web-site, or
other promotional literature/posters used by the camp. It is also understood that that
Scales Lake Park is not responsible for articles of clothing or personal belongings
damaged or missing in transit, loss or theft. Scales Lake Park is operated in
accordance with the U.S. Department of Agriculture policy which does not permit
discrimination because of race, color, sex, age, handicap, or national origin
I, the parent of _____________________________________agree to release and
hold harmless Warrick County, The Warrick County Dept of Parks and Rec. Parks
Board, The Warrick County Dept. of Parks & Rec., and Scales Lake from any and all
claims, liability, losses, injuries, demands, damages, actions, which I or my child, my
child’s parents, my child’s heirs, next of kin, assigns, and personal representatives may
have concerning my child’s attendance at the Scales Lake Park Summer Day Camp. By
signing this application you are also verifying that the above information is correct and
take full responsibility for any incorrect information.
___________________________________________
Signature of Parent/Guardian