Unitarian Universalist Santa Rosa (UUCSR) Chalice Camp 2022 Registration

August 1st - 5th at UUCSR -547 Mendocino Av, Santa Rosa | Welcome to Chalice Camp 2022 registration! Please fill out the following information about you and your child, click submit and check for a confirmation email! For inquiries and additional information, please contact Director of Religious Education Era Capone at DRE@UUSantaRosa.org
General Information

 
 
 
 
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Address

 
 
Emergency Contact

 
 
 
 
 
 
 
 
Medical Information

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Pick Up List

 
Parent/Guardian Authorizations and Permissions

By signing below you agree to:
• In case of medical emergency, I hereby give permission to the Camp Director or UUCSR staff to secure proper medical treatment for my child. In emergency cases, it is UUCSR policy to make every reasonable effort to contact the parent/guardian immediately. 

• Be responsible for all medical, hospital or other expenses not covered by my insurance carrier which may incur as the result of securing treatment.

• I assume responsibility for any liability which may arise for damages, loss or injuries which may be caused or contributed to by my child to the person or property of others.


• I understand the medical information must be completed.


• I understand that UUCSR is not responsible for my child’s personal property.




• I have read and accept the policies and fees printed on the UUCSR Chalice Camp application and registration forms.  I represent that the statements I make herein are true and accurate.

UUCSR will reasonably and to the best of its ability follow state and local guidelines put in place by the CDC, the California Health Department and the County. We will communicate to the best of our ability any changes that arise in the time before and during camp.

By signing below you agree to:


• Take full responsibility for assessing your child for symptoms of COVID-19 each day before they are dropped off at camp.


• Not allow your child to attend camp, and notify the director, on any day in which they meet the CDC criteria for symptoms of COVID-19 which is having one or more of the following:


▪ Cough


▪ Chills


▪ Sore Throat


▪ Shortness of Breath


▪ Muscle Pain


▪ Loss of taste or smell


▪ Difficulty breathing


▪ Headache


▪ Fever of 100.4 or more


• Not allowing your child to attend camp until you talk to the director if they have been diagnosed with COVID-19 or have symptoms of COVID-19.

 
Additional Information

 
 
 
 
Payment

 
 
 
 
 
 

Description

August 1st - 5th at UUCSR -547 Mendocino Av, Santa Rosa
Welcome to Chalice Camp 2022 registration! Please fill out the following information about you and your child, click submit and check for a confirmation email! For inquiries and additional information, please contact Director of Religious Education Era Capone at DRE@UUSantaRosa.org