21st Century Kids Summer Program for MSAD 58

How the Camp Will Run:

• The 21st Century Kids of Northern FRANKLIN will provide an in-person summer camp in Strong at the Day Mountain Regional Middle School (DMRMS). It is imperative that campers are able to adhere to the strict guidelines we are putting in place that make this summer camp possible. Parents will be notified within 5 business days whether their child has been selected for the program.

• Campers will have to be dropped off and picked up by designated adults at DMRMS. The camp will run for 6 weeks from 12-4 each day beginning July 1, 2024 and ending on August 8, 2024.

Important Mandatory Guidelines for Attending Camp:

• All personal items brought to camp must be kept to a minimum and must be labeled with the owner’s name. Campers will only be allowed to bring 1 bag with a bathing suit, towel, a water bottle, and a change of clothing to program. Absolutely no toys (land or water) or electronics will be allowed.

• Lunches will be provided.

Looking forward to a safe and fun summer,

The 21st Staff

Please list below 3 adults that you would like to be able to pick your child up and/or sign your child out from the program. Adults will be required to stay in their vehicles for drop off and pick up. Staff will chaperone campers to and from their vehicle.

Anyone who is picking up your child must provide a picture ID.

• Please drop off your child on time. The program begins at 12:00 AM Monday through Friday. Please do not drop off your child before 12:00 AM. Our staff will not be responsible for your child until 12:00AM.
• You must pick up your child by 4:00PM. The program ends promptly at 4:00 PM.
• Pick up after 4:00 pm will result in a fee of $5.00 per 15 minutes late. This will be strictly enforced this year. Payment must be made before your child can return to program.
• The 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff is relieved from the responsibility of looking after any child after s/he has left the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program.

• Health/Medical Information

• For the safety and best care of your child, please check below for any of the following that apply to your child, and provide as many details as possible.
• Medications
• Medical Conditions
• Recent Injuries
• Food Allergies
• Drug Allergies
• Other Conditions or Diagnoses
• Is there anything else you would like us to know?

• Parent/Guardian Release and Liability Form

  Please read and sign the standard releases and permission forms that are required to attend the summer program. Thank you. If you do not agree, please mark below the release which you do not agree with.
• For Emergency Treatment*
  • I AGREE
  • I DO NOT AGREE
  I authorize the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff to arrange for transportation in case of accident or acute illness of the participant. It is understood that every effort will be made to contact the parents or other priority person before treatment is given but that treatment will not be withheld if a parent cannot be reached. In the event it is not possible to receive instruction for the participant’s care, consent is given to any EMS or licensed physician for treatment. I allow the EMS staff and/or physician to administer medication and to perform necessary treatment for the preservation of the participant’s health and well-being. I understand that any cost incurred for treatment of sudden illness or accident shall be paid by me. This authorization and consent for treatment is given to the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and in conjunction with any authorized event. If you do not agree, this will affect your child's acceptance into the program.
• General Release of Liability*
  • I AGREE
  • I DO NOT AGREE
  I hereby assume full responsibility for any risk of illness, bodily injury, death, or property damage and/or while using the premises or any facilities or equipment hereon. I understand that this program includes physical activity and I also understand that any program or sport that includes such activity carries with it an inherent risk of physical injury. I further agree to hold harmless the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program, their partners, directors, officers, employees, agents, and volunteers from any and all claims that may result from any action for damages, included but not limited, to such claims that may result from injury or death, accident or otherwise, during or arising in any way from said activity. I acknowledge that this General Release of Liability of the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program, its partners is binding on me and my heirs, personal representatives, and successors. If you do not agree, this will affect your child's acceptance into the program.
• Release of Records*
  • I AGREE
  • I DO NOT AGREE
  As your child is enrolled in the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program, funded by Maine Dept. of Education through funding from the US Dept. of Education our use of this funding requires that we report certain results to the Maine DOE & U.S. DOE including free and reduced lunch status, special services, academic progress, student MEDMS (school identifier) number, attendance, discipline, behavior, surveys, activity participation, and classroom performance. In addition to compliance with reporting requirements, use of this data assists program managers to make informed decisions about program adjustments and improvements, matching students with needs, program sustainability, and program replication in other sites. Our reporting of positive student results may increase our chances of securing continued and additional funding to operate this program. All information collected will be restricted and used solely for serving student needs and approved program evaluation purposes. If you do not agree, this will affect your child's acceptance into the program.
• Field Trips*
  • I AGREE
  • I DO NOT AGREE
  The 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program may take walking-distance field trips during some programming hours. These field trip locations and dates will be shared with parents and guardians. We will always return by normal dismissal time, unless we notify you in advance. I give permission for my child to leave Kineowatha property under supervision of the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff, Partners, and Volunteers. While taking part in these community field trips I release the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program from responsibility for any risk of bodily injury, death, or property damage as covered in the “General Release of Liability”.
• Photo/Media Release*
  • I AGREE
  • I DO NOT AGREE
  I hereby consent to the use of my child’s name, likeness and speech in any audio tape, video tape, film or photograph made in any 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program activity for the business or publicity purposes of the program and its partners. Publicity may include posts on our “21st Century Kids of Northern Franklin” Facebook Page (@21stnorthernfranklin). We encourage you all to “like” us on Facebook to get the latest updates regarding the program. I understand that any participation offers no remuneration and that my child’s name, likeness, and speech may be edited, produced, recorded for distribution throughout the United States and abroad. I expressly release the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and its licensees, assignees, affiliates and successors from any privacy, defamation, or other partners have arising out of broadcast, exhibition, publication, or promotion of this program.

• Parent/Guardian Signature

• Parent/Guardian Signature*
• Date*
  MM slash DD slash YYYY