Day Camps 2024

Register for CAMP NORSE DAY CAMP

Participant (Camper) Details

Student First Name

Student Last Name

Preferred Name/Nickname

Student's Birthday

Gender

Address

Address Line 2

City

State

Zip Code

Home Phone Number

School (Fall 2024)

Grade (Rising Grade in Fall 2024)

Age on 1st Day of Camp?

Next - Camp Selection

Select Camp(s) - For Students in Rising Grades 6th-8th

Registration for Doctor for a Day is now CLOSED.

Select Camp(s) - For Students in Rising Grades 9th-12th

Heartsavers

Tuesday, July 30

messages.NumberOf

Registration FULL

AMOUNT

40.00

TOTAL

messages.NumberOf

NKU Discount Rate FULL

AMOUNT

35.00

TOTAL

Parent & Emergency Contact Information

Parent/Guardian Information

Parent/Guardian #1 Name

Parent/Guardian #1 DAYTIME Phone

Parent/Guardian #1 EMAIL Address

Verify Email Address

Place of Employment

Parent/Guardian #2 Name

Parent/Guardian #2 DAYTIME Phone

Parent/Guardian #2 EMAIL Address

Place of Employment

If there are any legal issues related to custody that we should be aware of, please provide us with an updated court document stating as such. We will abide by legal documents only when dealing with children and custody issues. Otherwise, either parent has equal rights to their child. (Attach any relevant document below)

Upload Document

Emergency Contact Information

If neither parent nor guardian is available in an emergency, please contact:

Emergency Contact Name #1 (NOT PARENT)

Emergency Contact Phone #1

Emergency Contact Name #2 (NOT PARENT)

Emergency Contact Phone #2

Next: Accomodations & Medical Information

Request for Accomodations & Student Medical Information

Request for Accommodations

If you believe your child may need accommodations to participate in this program, please list the requested accommodations and a staff member will be in touch with any additional questions.

List Accomdations

Medical Information/History, Assumption of Risk, and Healthy Attendance Policy

Does the participant have health insurance coverage?

Yes or No

Medical Insurer/Health Plan

Policy Number

Plan Number

Name of Family Physician

Physician’s Phone Number

The following information will be shared with the Camp Nurse to provide care to students during their time with us at camp. You may receive an additional form from our nursing provider after registration.

Does child have any of the following Allergies? (Check all that apply)

Hay Fever

Bee/Wasp Stings

Insect Stings

Penicillin

Peanut

Other Food/Drugs (explain below)

Other Allegies (Please List)

Other Conditions (select all that apply)

Asthma

Diabetes

Convulsions

Concussion

Behavioral/Emotional

Other Medical Conditions (Please explain)

What other specific information about your camp participant which the staff should be made aware of to provide a better camp experience for the camp participant?

Describe

Does the youth wear any medical appliances (glasses, contact lenses, orthodenture, etc.)?

If yes, list here:

Does the youth have any DIETARY restrictions? (i.e. vegetarian, vegan, gluten free, etc.)

If yes, explain:

Any major past illnesses (contagious and non-contagious)?

If yes, explain here:

Any major operations or serious injuries (include dates)?

If yes, detail here:

Has the youth ever been hospitalized (include dates)?

If yes, detail here:

Does the youth have any chronic or recurring illness?

If yes, explain here:

Is there anything else in youth’s health history that the program staff should know about?

If yes, explain here:

Are there any activities from which the youth should be restricted?

If yes, explain here:

Are there any specific activities that should be encouraged?

If yes, explain here:

NKU requires that, in order to participate in NKU camps, campers must have received all childhood immunizations required by Kentucky law or have received an appropriate exemption.

Has the youth received all legally required childhood immunizations?

Yes or No

If NO, please describe the basis of the exemption. NKU may require additional documentation:

Attach Document

I agree that my child will not attend the program if they are symptomatic of any commonly spread transmissible illness. (Agree by checking the box)

In the event that an illness or injury would require more extensive evaluation, I understand that every reasonable attempt will be made to contact me. However, in the event of an emergency and if I cannot be reached, I give my consent for licensed health care practitioners to perform any necessary emergency treatment. (Agree by checking box)

I understand that NKU does not provide medical insurance to cover emergency care or medical treatment of my child. (Agree by checking the box)

NKU is committed to protecting the medical and related health information about your child. Medical and related health information provided on this form will only be used as necessary to provide services for your child while participating in the Youth Program.

If there are any changes to your child’s health, please contact the youth program.

Medication Management

It is NOT permissible for a participant to share any medications with any other participants. If at all possible, medication should be administered at home. Medications will be allowed at the Youth Program when failure to take such medicine would jeopardize the health of a child and he/she would not be able to attend the Youth Program if the medicine were not made available.

The parent(s)/legal guardian(s) of Youth Program participants are required to disclose their intention to bring medications to the Program, especially to treat potentially life-threatening conditions (i.e. inhalers, EPI-pens, insulin injections). Upon arrival to the Program, parent(s)/legal guardian(s) should plan to meet with a member of the Youth Program staff at registration to review medication issues for a Youth Program participant and complete additional required paperwork if not completed prior to arrival.

All medications (prescription and over-the-counter) must be stored in the original product packaging and clearly labeled with the participant’s name. Prescription medication(s) must also include a label with the medication’s name and dosage instructions, as well as the prescribing physician’s name and telephone number.

All medications will be kept in a securely locked cabinet used exclusively for storage of medications. Medications that require refrigeration will be stored and locked in a refrigerator designated for medications ONLY. Access to all medications will be limited to approved personnel. The need for emergency medication may require that a Youth Program participant carry the medication on his/her person or that it be easily accessed (i.e. inhalers, EPI-pens, insulin injections, seizure medication). NKU Youth Program staff will NOT purchase medications of any type (prescription or over-the-counter) for Youth Program participants of any age.

NKU youth program does not carry over the counter medication. If a Program has professional medical staff on-site, then the medical staff may administer over the counter medications (e.g., ibuprofen or Tylenol) supplied by the parent(s)/guardian(s) per package instructions. Medical staff may monitor the self-administration of medications, if necessary, upon written consent of the parent(s) and/or legal guardian(s) and/or physician orders.

If there are no medical staff on-site, NKU Youth Program staff will not dispense medications, but may monitor the self-administration of certain medications if necessary, ONLY upon written consent of the parent(s)/legal guardian(s) and /or physician’s orders.

It is the responsibility of the parent(s)/legal guardian(s) to be sure that the participant’s medications brought to the Youth Program are not left behind at the end of the Program. Failure to do so will result in the medications being destroyed within three working days after the participant’s last day at the Program. Absolutely no medications will be returned via mail regardless of circumstance.

I understand that, in accordance with Youth Program policy, any medication(s) should be given at home before and/or after the Youth Program. However, when this is not possible, and medications will be brought to Youth Program camp, I agree to the provisions outlined above relating to the management of medications. Check box to agree:

Does your student need medication administered during camp hours (9 am - 3:30 pm)?

Yes or No

If YES, please list the specific prescription or over-the-counter medications below, reasons for medication, and daily dosage. If any medications change prior to arriving at the program, please provide an updated list upon arrival. List: Medication Name, Reason for Medication, Dosage Instructions

If yes, NKU is unable to administer medication, however parents are welcome to stay close-by in the co-working space to easily provide medication administration.

Medication Details

Next: Drop-Off and/or Pick-Up Authorization & Transportation Information

Drop-Off and/or Pick-Up Authorization

Please list the NAMES & PHONE numbers of people including parent/legal guardian that have permission to drop-off and/or pick-up your child. Please list everyone who might be taking part.

Adult #1 (Name & Phone)

Adult #2 (Name & Phone)

Adult #3 (Name & Phone)

Adult #4 (Name & Phone)

Adult #5 (Name & Phone)

The above individuals will be asked to verify their identity by showing an official picture ID before your child will be released into their care.

If there are any legal issues related to custody that we should be aware of, please provide us with an updated court document stating as such. We will abide by legal documents only when dealing with children and custody issues. Otherwise, either parent has equal rights to their child.

Any special drop-off/pick-up Instructions?

Optional: Walk/Bike/Drive Authorization

For the safety of your child, we must have on file, a written authorization/permission form from the parent/legal guardian, permitting your child to walk/bike/drive to and/or from the program.

Please note that this permission is for the child to leave camp without adult supervision. For your child’s safety, campers may walk home, bike home, drive home or wait at a bus stop unsupervised only when a permission slip is signed, dated by parent/legal guardian, and is on file at the NKU Youth Program identified above. Campers will only be released at the scheduled program ending time, or at another time designated to the program in writing or in person by the parent/legal guardian. If the NKU Youth Program identified above does not have this signed slip, your child will not be released without authorized adult supervision. You will be called to pick him/her up from camp.

How will your child travel?

If you child will be dropped off and picked up each day, go ahead to the next page. If they will be traveling unsupervised, please complete the following questions.

My child will arrive or depart by: (check all that apply)

Walk

Bike

Use Public Transportation

Drive Themselves (approximately $10 per day in the Kenton Garage)

By signing this waiver, I authorize my child to walk, bike or drive to and/or from the NKU Youth Program identified above. This includes permission to walk home from my child’s regularly scheduled bus stop and includes waiting at the bus stop unsupervised if you have signed your child up for public transportation. (Agree by checking box below)

Codes of Conduct

I understand that my child will be subject to the rules and standards of conduct of Northern Kentucky University (“NKU” or the “University”) when participating in a University-sponsored program. I further understand that my child’s violation of the rules and standards of conduct or failure to comply with the reasonable direction of Program Staff or University employee may result in my child’s dismissal from the Program. (Check box to agree)

Camper Code of Conduct and Expectations

Campers are not permitted to use cell phones during camp programming. They may make calls at lunch or in scheduled free tme.
Possession or use of alcohol, illegal drugs, or weapons by any person is prohibited.
Use of tobacco products is not allowed on campus.
Camp participants are to be attentive, responsive and courteous to any staff, faculty or other adult making a presentation before the group.
Accidents or illnesses, no matter how minor, are to be reported to the Program Director. If medical care is needed, the Program Director will coordinate treatment with a local medical professional.
Obscene, discriminatory and/or inappropriate language or dress, roughhousing, and insubordination is not acceptable at any time.
Camp participants are always to remain with their groups, and must obey the rule of 3 when traveling.
Camp participants are not permitted to leave campus at any time.
Camp participants who are having personal conflicts with others should discuss these with the Program Director.
Grounds are to be kept clean at all times. Camp participants are expected to leave the facilities and grounds clean and orderly.
Camp participants are to respect camp property. Any misconduct resulting in damage to camp property or buses, including graffiti, shall be paid for by the camp participant and/or parent or guardian. A list of damage fees is available.
Camp is not responsible for personal property of any camp participant or staff.
We care about the safety of all camp participants. Incidents of serious misbehavior (i.e. threats, fighting, bullying, causing injury, alcohol/drug incidents, any altercations between adults and/or minors, intentional property damage/vandalism, etc.) will be reported to the Program Director and an incident report will be completed.

Camp participants should demonstrate respect toward others. Bullying, hazing, or pranks (i.e.: shaving cream, toothpaste in pillow/sleeping bags, defacing property, including inappropriate use of electronics/social media) will not be tolerated and may result in the camp participant being sent home

Next: Waivers

Voluntary Release of Liability and Assumption of Risk (Minors)

The undersigned has requested that the Student be allowed to participate in Camp Norse. In exchange for Northern Kentucky University agreeing to allow the Student to participate in Camp Norse, the undersigned parent/guardian acknowledges and agrees as follows:

Release, Discharge, and Covenant Not to Sue

The undersigned, on behalf of him/herself and the Student, hereby releases Northern Kentucky University, its regents, officers, employees, agents, and contractors (collectively “Releasees”) from any and all claims and liability arising out of Student’s participation in the program and all related activities, including acts and omissions of Releasees (INCLUDING RELEASEES’ ORDINARY NEGLIGENCE) that cause injury, death, permanent disability, economic loss, and/or property damage to Student and/or the undersigned. The undersigned, on behalf of him/herself, the Student, and their respective heirs, executors, and administrators, hereby covenant not to sue Releasees for any such claims.

I UNDERSTAND THAT I AM RELEASING NORTHERN KENTUCKY UNIVERSITY FROM LIABILITY AS DESCRIBED HEREIN, AND I AM VOLUNTARILY SIGNING THIS DOCUMENT IN EXCHANGE FOR PERMISSION THAT THE STUDENT MAY PARTICIPATE IN THE PROGRAM. (Check box to agree)

Parent/Guardian - Type Name to SIGN

Title IX Policies & Procedures and Reporting Concerns

All Northern Kentucky University youth programs have policies in place to ensure the safety of youth participating in our programs, activities and services is not compromised. All program staff are trained in emergency protocols and all relevant internal, external, and parental reporting requirements.

Title IX prohibits sex discrimination (including sexual harassment and/or sexual abuse) against Youth Participants in any of the University’s education programs or activities, including recreational and/or athletic programs or services operated by the University. Please click here to review the University’s Title IX policy and procedures.

To report an incident of suspected sex or gender-based discrimination, please contact NKU’s Title IX Investigator, using the contact information below:

Keisha McCraney J.D., Title IX Investigator
University Center, Room 330C
Highland Heights, KY 41076
Phone: (859) 572-7669
Email: mccraneyk1@nku.edu
or submit the Online Reporting Form.

Parents are encouraged to notify the program director immediately if they, or their child, are experiencing problems, difficulties, or concerns with the program, other youth in the program, and/or staff. You may also call the University's Ethics Hotline at 1-855-597-4539.

Media Release

I authorize Northern Kentucky University and its employees and agents to make films, photographs, and similar recordings of my child solely for purposes of University’s marketing and promotional activities regarding the program. (Check box to agree)

Today's Date

Summary

Terms and Conditions

Cancelations & Refunds: If you cancel before the standard registration date (two weeks before the start of the program), you will receive a refund less the 10% non-refundable registration fee. Cancellations after the standard registration date are nonrefundable.

Agree

Next: Payment

Payment

This page may take a few moments to process. Please click the Submit button only once. Do not refresh your browser or click the back button until you see the Thank You page. If you are requesting finanical assistance (scholarships), your amount below should be zero. You will be contacted by staff after review of your application.

Payment Processing

Thank You

Please look for an email from mail@eventsairmail.com. This will be your confirmation email and will show your selections and payment information. If you have any questions about registration or payment, please contact connect@nku.edu.

If you have specific questions about the camps, please contact Carolyn Noe at noec2@nku.edu.

Terms & Conditions: If you cancel before the standard registration date (two weeks before the start of the program), you will receive a refund less the 10% non-refundable registration fee. Cancellations after the standard registration date are nonrefundable.

If you would like to register another student, return to https://nku.eventsair.com/campnorse/registration.

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Register for CAMP NORSE DAY CAMP

Participant (Camper) Details

Select Camp(s) - For Students in Rising Grades 6th-8th

Select Camp(s) - For Students in Rising Grades 9th-12th

Heartsavers

Parent & Emergency Contact Information

Parent/Guardian Information

Emergency Contact Information

Request for Accomodations & Student Medical Information

Request for Accommodations

Medical Information/History, Assumption of Risk, and Healthy Attendance Policy

Does child have any of the following Allergies? (Check all that apply)

Other Conditions (select all that apply)

Medication Management

Drop-Off and/or Pick-Up Authorization

Optional: Walk/Bike/Drive Authorization

My child will arrive or depart by: (check all that apply)

Codes of Conduct

Voluntary Release of Liability and Assumption of Risk (Minors)

Title IX Policies & Procedures and Reporting Concerns

Media Release

Summary

Terms and Conditions

Payment

Thank You

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