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                                     Camp Cahito
                            Summer 2009: Extreme Adventures
Enclosed in this packet are the documents needed to register your camper for Camp Cahito. The
checklist below will help guide this process. Please make sure all forms are complete and signed by
parent and/or guardian before sending them to us.
Please mail all packets to:
* Camp Fire Day Camp – Post Office Box 3275, San Diego, CA 92163
All campers must submit to Camp Cahito the following forms. Some require a signature by a parent
and/or guardian.

              Registration Form
              Health History Form
              Reach-Out/Low Ropes Challenge Course Participant Release Form
              Participation Agreements
              Program Selection Form
              Payment Information Form
Please note:

           One registration packet per camper.
           Friend request must be in the same grade. We do our best to place friends in the same
            group, however there is no guarantee.
           A $75/per session deposit must be included in order for packet to be processed.
           If you are interested in our DASH (Director and Staff Helper) or Junior Counselor
            Programs, please request Teen Leadership Packet for ages 12 and up from office.
           Please call with further questions.
                   We look forward to another amazing experience at Camp Cahito!
                                             WoHeLo,
                                          Kristin Vasquez
                                   Director of Outdoor Education




                                      Camp Fire USA – SDI
                               P.O. Box 3275, San Diego, CA 92103
                               P: (619) 291-8985 F: (619) 291-8988
                                       www.campfiresdi.org
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                                                                                             Office Use Only
 Camp Fire USA - SDI                                                                         Date Rec’d _______________
 Camp Cahito                                                                                 Invoice # _________________
 Camper Registration Packet                                                                  Inv Mailed ________________
 Post Office Box 3275                                                                        Paid In Full _______________
                                                                                             T-Shirt Size_______________
 San Diego, CA 92163                                                                         Letter Mailed ______________
 (619) 291-8985                                                                              Circle One: LS SF ADV DIS
 www.campfiresdi.org                                                                         Staff Initials _______________
                                                Registration Form
                                                   Camper Information
Camper Name                                     Birth Date                                       Male                 Female
Address                                                                                         Apt. #
City                                            State                                           Zip Code
Home Phone (        )                                           Cell Phone (             )
Name of Child’s School
Age at Camp         Grade in the Fall               School email if available:
                                       Parent and/or Guardian Information
1. Parent/Guardian Name                                         Employer
Address                                                                                         Apt. #
City                                            State                                           Zip Code
Home Phone (       )                                            Cell Phone (             )
Work Phone (       )                                            Email Address

2. Parent/Guardian Name                                         Employer
Address                                                                                         Apt. #
City                                            State                                           Zip Code
Home Phone (       )                                            Cell Phone (             )
Work Phone (       )                                            Email Address
                         Emergency and Authorized Pick Up/Drop Off Contacts
Please list people other than the above parents and/or guardians. No child will be released to anyone not
listed below. Everyone who picks up your child must show photo identification.
Name                                     Phone (        )                       Relationship
Name                                     Phone (        )                       Relationship
Name                                     Phone (        )                       Relationship
Name                                     Phone (        )                       Relationship
                                                        Demographics
This information is optional and helps us to apply for grants, camperships and other funding to help support
our outdoor education programs.
                                                    Ethnicity
 African American  Asian  Caucasian  Latino                                 Multi-Racial  Other
                                             Household Structure
 Two Parents  Single Parent  Guardian  Foster Parents                  # of Persons in Household
                                          Annual Household Income
 < $15,000  $15,001 - $40,000  $40,001 - $65,000  $65,001 +
                                                             T-Shirt
 Youth     Adult                          X-Small  Small  Medium  Large  X-Large  XX-Large
                                                      Friend Request
            While we do our best to pair up friends, at times it is not possible due to ages and grades of the children.
                                          Friends must be in the same grade in school.

Friend’s Name                                                                          Age:             Grade in the Fall:
Friend’s Name                                                                          Age:             Grade in the Fall:
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Camper Name                                                                 Date of Birth:                  Current Age:
                                                      Health History Form
This form will be kept confidential. Your registration will not be processed if incomplete. A copy of the
camper’s immunization record must be attached to this form.
Doctor Name                                                                  Phone (        )
Doctor Address                                                               Suite #
City                                      State                              Zip Code
Is the child covered by an insurance plan?  Yes  No
Insurance Name                                                               Group #
Subscriber Name                                                              Employer
Please use this space to share any immediate emergency information we should know about your child’s health. State
anything that would help an emergency room staff in the event we must take your child to the hospital.


                                                          Immunization Record
            Vaccine                             Date Given                            Vaccine                    Date Given
Polio                                                                      Hepatitis B
DTaP                                                                       Varicella (Chicken Pox)
HIB                                                                        Hepatitis A
MMR                                                                        Pneumococcal
TB or X-Ray IS Required This test must be within current year              Results of TB Test  Positive  Negative
unless the children tested positive and is required to have an X-ray.      Results of X-Ray and date: ___________________________
The X-rays are only required every 3-5 years. Ask your child’s doctor.
                                                                         Other
The following questions are important. Please attach any additional information you feel we should know
about your child.
Has your child had any of the following diseases?         Allergies – Please be specific and explain reaction and
If yes, list when.                                        if medications are needed.
Measles?                               Yes  No Food
German Measles?                        Yes  No Peanuts/Nuts
Mumps?                                 Yes  No          Insects
Hepatitis A?                           Yes  No Medications
Hepatitis B?                           Yes  No Plants
Tuberculosis?                          Yes  No Dust or Dander
Meningitis?                            Yes  No          Other
Has your child had any recent injuries, illness, infectious diseases we should know about?          Yes  No
Does your child have any chronic or recurring illness or condition?                                 Yes  No
Does your child have any heart problems we should know about?                                       Yes  No
Does your child have frequent headaches?                                                             Yes  No
Does your child wear glasses, contacts or protective eyewear?                                        Yes  No
Does your child have limited hearing and need assistance with hearing?                               Yes  No
Does your child have problems with diarrhea or constipation?                                         Yes  No
Does your child have hay fever or allergies to dust, weeds or animals?                               Yes  No
Has your child ever passed out during an activity at school or another camping experience?           Yes  No
Has your child been diagnosed with ADD? If yes, list medication your child is on.                    Yes  No
Does your child have asthma? If yes, list medication your child is on.                              Yes  No
Please help us to create a positive experience for your child and share any other issues or concerns , whether physical, mental or
social.

List medications in use – Please be advised that only prescribed medications will be given to your camper. We are not allowed to
dispense any over-the-counter medications.
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Camper Name                                Birth Date             Current Age:        Male              Female
                       Reach-Out/Low Ropes Challenge Course
                              Participant Release Form
The following form is required for all ages. Children will participate in a developmentally appropriate course
for their age group. While some of the information on this form may appear to be duplicated, this form is
required and will be kept in a separate file just for our Reach-Out/Low Ropes Challenge Course certification.
Address                                                                            Apt. #
City                                       State                                   Zip Code
Doctor Name                                               Phone (        )
Doctor Address                                                                     Suite #
City                                       State                                   Zip Code
Is the child covered by an insurance plan?  Yes  No
Insurance Name                                                                Group #
Subscriber Name                                                               Employer
1. Parent/Guardian Name                                             Phone (        )
2. Parent/Guardian Name                                             Phone (        )
                        Emergency and Authorized Pick Up/Drop Off Contacts
Please list people other than the above parents and/or guardians. No child will be released to anyone not
listed below. Everyone who picks up your child must show photo identification.
Name                                      Phone (          )                        Relationship
Name                                      Phone (          )                        Relationship
If participant has been under the care of a physician within the past 12 months or if there are any restrictions
on activity, attach a statement from a physician indicating restrictions.
Please list any known physical, mental, social difficulties, or other specific information which may affect
participation in the Reach-Out/Low Ropes Challenge Course.




I give authorization for me and/or my child to participate in the Reach-Out/Low Ropes Challenge Course held
at Camp Fire USA’s Camp Cahito at 3101 Balboa Drive, San Diego, CA 92103. I acknowledge that under
certain circumstances the activity could be dangerous and that I am not, nor is my child, required to
participate in this activity. I therefore expressly request that I and/or my child be able to voluntarily participate
in this activity. I understand and acknowledge that I waive and forever release and discharge the Camp Fire
USA San Diego & Imperial Counties (CF-SDI) Council and its officers, employees, agents, and volunteers
from all liability claims, losses, costs, or expenses arising from, or attributable to, the activity identified above.
In addition, I further agree to defend, indemnify, and hold harmless CF-SDI from and against any loss,
judgment, fine, penalty, fees, or costs (including third parties’ or CF-SDI’s own attorneys’ fees and costs
whether or not a suit is brought) arising from any allegation or claim for injuries, damages, or losses of any
kind resulting from me and/or my child’s participation in the Reach-Out/Low Ropes Challenge Course. To the
best of my knowledge, I do not, nor does my child, have any physical condition that would interfere with
my/his/her ability to participate in or attend this challenge course activity or would endanger my/his/her health
or any other participant. Should I or my child require medical treatment while participating in this activity, I
hereby give CF-SDI permission to use its judgment in obtaining medical service for me or my child, and I give
permission to the physician selected by CF-SDI to render medical treatment deemed necessary and
appropriate by the physician. I understand that CF-SDI has no insurance covering any medical or hospital
costs that might be incurred by me and/or my child and, therefore, any cost incurred for such treatment shall
be my sole responsibility.
I have read and understand the policies regarding participation in the Reach-Out/Low Ropes Challenge
Course programs.

Signature Parent/Guardian:___________________________________________________________
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Camper Name                                            Please read and sign below each topic. Thank you.
                                    Participation Agreements
                                     Camp Cahito General Agreement
I, parent/guardian wish to have my child participate in the camping program sponsored by Camp Fire USA –
San Diego & Imperial Counties Council, hereby known as CF-SDI. I further agree that all children
participating in the outdoor education program must follow safety instructions, remain in their assigned areas
as designated by staff, and refrain from behavior that is harmful to him/herself or other children and adults.
Failure to follow camp rules will be cause for my child’s dismissal from the outdoor education program without
a refund. I also understand that in order to provide a safe and cooperative group experience my child may be
dismissed for reasons including negative behavior, contagious illness, injury to self or others and
homesickness.
I have read and understand the policies regarding participation in the outdoor education programs and the
safety for all children who attend Camp Cahito.

Signature Parent/Guardian:________________________________________________________________

                                             Emergency Release
I, parent and/or guardian recognize there may be risks of injury during my child’s participation in an outdoor
education program at Camp Cahito and that in spite of preparing a risk management plan with the safety of
the children in mind, certain dangers and accidents may occur. In consideration of the benefits to be received
as the result of my child’s participation in the outdoor education program, the receipt and sufficiency of which I
hereby acknowledge, I hereby release, acquit and forever discharge CF-SDI, its officers, directors, trustees,
employees, agents, and insurers of each of them, from all claims, responsibilities of liability of whatever kinds
and nature, whether arising from negligence, breach of contract or otherwise, on account of or arising from
any injury or damage which may be sustained by my child as a result of my child’s participation in the CF-SDI
outdoor education program. I agree to defend and indemnify CF- SDI and other officers, directors, trustees,
employees, agents, and insurers of each of them against any and all manner of actions, claims, demands,
damages, liabilities, or expenses of every kind and nature which may be incurred or arise by reason of my
child’s participation in the outdoor education program, including but not limited to any injury my child may
cause to other participants. I give permission to the physician selected by the Program Director or Executive
Director to secure and administer treatment, including hospitalization and transportation via a 911 EMT
ambulance, for my child in the event of a serious emergency where immediate transport to a hospital is
needed. I agree to be responsible for any and all expenses that may be incurred in providing emergency
medical or surgical treatment to my child. My child has my permission to participate in any and all camp
activities and to receive information regarding enrichment programs provided by CF-SDI.
I have read and understand the policies regarding emergency release.

Signature Parent/Guardian:________________________________________________________________

                                            Photo Release Form
During camp, still photographs and moving videos may be taken of my child while engaged in camp activities.
It is possible that my child and his/her name and voice may be chosen for future brochures, fliers, newspaper
or publicity purposes to promote our programs.

I have checked my approval or disapproval below:
 I WILL allow photos/videos of my child to be used in Camp Fire USA-SDI.
 I WILL NOT allow my child’s photo to be used in any way by Camp Fire USA – SDI.
I have read and understand the policies regarding photo release.

Signature Parent/Guardian:________________________________________________________________
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Camper Name                                           Please read and sign below each topic. Thank you.
                          Participation Agreements, Continued
                                        NO Cell Phone Policy      
I understand that Camp Cahito is a CELL PHONE FREE ZONE. I will not send a cell phone with my child. I
understand that any cell phone that is in use by my child, or found in a place belonging to my child will be
taken away until the end of the camp day and a warning will be issued to both me and to my child. A second
infraction to adhere to the “NO Cell Phone Policy” could be cause for my child’s dismissal from our outdoor
education program without a refund. I understand that staff have cell phones for any and all emergencies and
therefore, a phone is available at all times in the event that one is needed. I also understand that an outdoor
education program is not a place for a child to need a cell phone.
I have read and understand the policies regarding the no cell phone policy.

Signature Parent/Guardian:________________________________________________________________

                                              Payment Policy
Due to the rising costs involved in billing and the cost of staff time to process the invoices for outstanding
payments, I understand that it is my responsibility to PAY IN FULL (including any costs for extended care)
one week prior to the first day of camp. Any outstanding balances and invoices which must be mailed will
be charged a $5.00 billing fee. Reservations are required for extended care and will not be reimbursed if
unused. Last minute extended care must be paid at the time of pick up. Outstanding balances on the day
camp begins could be cause for my child to be turned away, if payment is not made in full upon arrival.
I have read and understand the policies regarding the payment policy.

Signature Parent/Guardian:________________________________________________________________
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Camper Name                                          Birth Date                                Male            Female

                                                   Program Selection Form
     Little Stars Camp – Preschool: Half day only for ages 3 and 5 year olds, 9:00- Noon     1:6 Camper to staff ratio.
     Starflight Camp – Children entering Kindergarten, 1st or 2nd grade in the Fall.   1:8 Camper to staff ratio.
     Adventure Camp – Children entering 3rd thru 6th grade in the Fall. 1:10 Camper to staff ratio.  Overnight available for this age group.
     Week                   Session                                  Camp                               Extended Care (Circle Days)
     Week 1       Mission Impossible            Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
6/22/09 – 6/26/09                               Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
     Week 2       Celebrate the USA             Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
6/29/09 – 7/3/09                                Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
     Week 3       Time Travel                   Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
7/6/09 – 7/10/09  Overnight is 7/9/09.         Full Day 9:00 AM – 3:00 PM $165   $50 3:30 – 5:30 PM M T W TH F
     Week 4       Cooking Up a Storm            Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
7/13/09 – 7/17/09                               Full Day 9:00 AM – 3:00 PM $175                 3:30 – 5:30 PM M T W TH F
     Week 5       Mad Scientist                 Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
7/20/09 – 7/24/09                               Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
     Week 6       Got Talent                    Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
7/27/09 – 7/31/09                               Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
     Week 7       Save the Earth                Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
 8/3/09 – 8/7/09                                Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
     Week 8       Pirates of Cahito             Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
8/10/09 – 8/14/09  Overnight is 8/13/09.       Full Day 9:00 AM – 3:00 PM $165   $50 3:30 – 5:30 PM M T W TH F
     Week 9       Flower Children of Cahito     Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
8/17/09 – 8/21/09                               Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
    Week 10       Camper vs. Wild               Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
8/24/09 – 8/28/09                               Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
    Week 11       Tie it all Together           Half Day 9:00 AM – 12:00 PM $125                7:00 – 9:00 AM M T W TH F
8/31/09 – 9/4/09                                Full Day 9:00 AM – 3:00 PM $165                 3:30 – 5:30 PM M T W TH F
  Discovery Camp – Children entering 7th           th
                                              thru 9 grade in the Fall. 1:10 Camper to staff ratio. This is a 2 wk camp with 1 overnight.
     Week                   Session                                  Camp                               Extended Care (Circle Days)
  Weeks 2 & 3       Celebrate Life & Nature     Full Day 9:00 AM – 3:00 PM $325                   7:00 – 9:00 AM      M    T    W    TH     F
6/29/09 – 7/3/09     Overnight is 7/2/09        $50 for 7/2/09 Overnight                        3:30 – 5:30 PM      M    T    W    TH     F
                    and 7/9/09.                  $50 for 7/9/09 Overnight                        7:00 – 9:00 AM      M    T    W    TH     F
7/6/09 – 7/10/09                                                                                   3:30 – 5:30 PM      M    T    W    TH     F
  Weeks 8 & 9       Explore Independence        Full Day 9:00 AM – 3:00 PM $325                   7:00 – 9:00 AM      M    T    W    TH     F
8/10/09 – 8/14/09    Overnight is 8/13/09       $50 for 8/13/09 Overnight                       3:30 – 5:30 PM      M    T    W    TH     F
                    and 8/20/09.                 $50 for 8/20/09 Overnight                       7:00 – 9:00 AM      M    T    W    TH     F
8/17/09 – 8/21/09                                                                                  3:30 – 5:30 PM      M    T    W    TH     F
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Camper Name
                                    TUITION AND EXTENDED CARE - STATEMENT
Extended hours are available for all campers. Please circle the options you need on page # 7. Please note that if you
do not sign up for extended hours but your camper is in camp between the hours of 7:00 – 9:00 AM or after 3:30 PM,
you will be required to pay a fee for those hours on a drop in basis which is $5 per hour or any part of any hour.
Extended hours must be prepaid and are nonrefundable if unused.

Camp is officially over at 5:30 PM. Over-Time care after 5:30 PM will be charged $5 for every 15 minutes the
parent/guardian is late.

In order to provide a safe environment and have the right camper to staff ratios, we must know how many children will be
in our care at all times.
     AM
     PM
                          7:00 – 9:00 AM
                          3:30 – 5:30 PM
                                              $12.50/day - AM Total number of days on page # 7 circled
                                              $12.50/day - PM and enter in the box on the right:                                 
        Last minute drop in care is $15.00 AM + $15.00 PM and is payable on pick up that day by check.
                                            PLEASE NOTE PAYMENT POLICIES
A $75 deposit per session will hold your child’s place at registration.

Tuition and Extended care payment IN FULL is required one week (7 days) prior to the first day of camp.

There is a billing charge of $5.00 to cover any accounting, paper and postage for tuition that is not paid on time.
* In order to save on costs for billing, it is the parent/guardian’s responsibility to pay on time prior to the start of camp.

Please note: If payment is not made in full by the Friday before camp begins, your child’s place will be filled from the waiting list. The
$75.00 deposit will be applied to your camp fee however will not be refunded due to a last minute cancellation.

                                                                PAYMENT
Total Weekly Camp Tuition (Add amounts next to boxes checked above)                                              $
Total Extended Care Fees (Multiply $12.50 by number of days above)                                               $
Campership Donation – If you would like to donate to our campership fund, please enter                           $
amount here. Your donation will send a less fortunate child to camp!
Total Discounts/Camperships                                                                                      (-)

Total Charges                                                                                                    $
 Deposit for # ____ of sessions at $75 each week =                              Total Deposit:                  $ _______________

 I WISH TO PAY the Full Amount =                      Total Payment in full: $ _______________
 Check # ________
 Visa               Credit Card # _______________________________________
 Master Card        Expiration Date: ________________


Name on the Credit Card : (Please print) _________________________________________________

Card Holder Signature:                               _________________________________________________

Please mail all packets to:

                         % Camp Fire Day Camp – Post Office Box 3275, San Diego, CA 92163

				
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