Camp Hope Horizon Registration Summer 2025

Camp Hope Horizon East Palo Alto 2025

Student Information / Información del estudiante

Name/ Nombre

Gender/Género

F M

Birth Date/ Fecha de nacimiento

Age/Anos

Grade completed in 2024-2025 / Grado completado en 2024-2025

Phone/Telefono

Address/domicilio

School/Escuela

Allergies/Alergias

Medication/Medicación

Parent Information

Name/Nombre

Phone/Teléfono

Email/Dirección electrónico

This address will receive a confirmation email

Relationship /Relación

Child lives with/ Niño/a vive con

Emergency Contact/Contacto de emergencia

Name/Nombre

Phone/Teléfono

Relationship/Relación

Permission to walk home/contacto de emergencia

Walk Home/ Permiso para caminar

Yes No

Administering Medication/Administrar medicamentos

Would you allow Camp Hope Horizon staff to administer medication to your student?/ ¿Permitiría que el personal de Camp Hope Horizon administre medicamentos a su estudiante?

Yes No With Permission N/A

Authorized Pick Up Person(s)

Authorized person means a person approved or authorized to pick-up your student / Persona autorizada significa una persona aprobada o autorizada para recoger a su estudiante

Authorized Person #1/ Persona autorizada para recoger a los estudiantes #1Authorized Person #1

Authorized Person #2/ Persona autorizada para recoger a los estudiantes #2

If you decide to opt out of any spiritual components of our Hope Horizon East Palo Alto programming, your student will be excluded from participation in discipleships, mentoring, spiritual activities, retreats, and any spiritual programming.

Si decide optar por no participar en ningún componente espiritual de nuestra programación Hope Horizon East Palo Alto, su estudiante será excluido de la participación en discipulados, tutorías, actividades espirituales, retiros y cualquier programación espiritual.

Please indicate if you DO NOT want your child to be included in spiritual programming by checking the box / Indique si NO desea que su hijo sea incluido en la programación espiritual marcando la casilla:

I DO NOT want my child to be included in spiritual programming / NO QUIERO que mi hijo sea incluido en la programación espiritual I WANT my child to be included in spiritual programming / QUIERO que mi hijo/hija sea incluido en la programación espiritual

I understand that all releases listed below apply to all participants, parent/s & or guardians:

For your child(ren) and or parent/s/guardian to be a participant/s in our programs, we must have permission for the following:

Permission to participate in Hope Horizon East Palo Alto Programs

I give permission for my child(ren) to participate in all program activities including biblical teaching, outings, sessions, workshops, sports, performance/s, and any other functions.

Performance/Publication/Media Rights Release

• Recognizing that all items listed below are strictly for the purpose of promoting Hope Horizon East Palo Alto Programs:

• I give Hope Horizon East Palo Alto the right to publish and copyright any and all creative works generated by my child(ren) in the following media: social media, book, newspaper, magazine, radio, television, videocassette, etc.

• I further permit Hope Horizon East Palo Alto to use any photographs, video images and sound, and/or audio sounds of my child(ren) for the purpose of promoting Hope Horizon East Palo Altoprograms.

• I forfeit the right to be compensated for any of the above for my child(ren), myself, or my heirs.

Release of Liability

• In consideration of being allowed to participate in Hope Horizon East Palo Alto athletic programs, related events, and activities it is agreed that:

• The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

• I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and assume full responsibility for participation; and

• I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard, I will bring such to the attention of the nearest official immediately; and,

• I, for myself and on behalf of my heirs, assigns, personal, personal representatives, and next of kin, hereby release, discharge, and hold harmless Hope Horizon East Palo Alto their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability, death, or loss or damage to person or property, to the fullest extent permitted by law, whether arising from negligence or otherwise.

Medical Release/Permission for Treatment/Release to Administer Medicine

I give authorization for Hope Horizon East Palo Alto staff members to administer the medications(s) listed below and any others in writing at a future date as authorized or directed by a doctor, parent, and/or guardian. I agree to release Hope Horizon East Palo Altofrom any liability related to medications, which are permitted to be administered as noted below.

I do hereby authorize all volunteers and employees of Hope Horizon East Palo Alto as an agent(s) for the undersigned to consent to any x-ray, examination, anesthetic, medical and/or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provision of the Medicine Practice Act or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or surgeon or at said hospital.

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required and is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent for any and all such diagnosis, treatment, or hospital care which the aforementioned physician or surgeon, in the exercise of his/her best judgement, may deem advisable. I also agree to release Hope Horizon East Palo Alto, its staff and volunteers from any financial responsibility related to any and all such diagnoses, treatment or hospital care mentioned above. I, the parent/guardian of participants listed on Side 1, have read, understand and agree to all of the releases noted above.

Note: All of the above releases will remain in effect for the entire time each participant is enrolled in Hope Horizon East Palo Alto's programs or until revoked in writing to the address listed below.

By submitting this form, you verify that you are the legal parent or guardian of the registered student.

Registration Fee // Cuota de inscripción

PLEASE USE DROP DOWN TO SEE PAYMENT OPTION// POR FAVOR UTILICE EL DESPLEGABLE PARA VER LA OPCIÓN DE PAGO

You have the option to pay the full camp registration fee in full upon submission of this application. If you opt to pay at a later time, please note that your student is not fully registered in camp until the registration fee has been received.//
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//Tiene la opción de pagar la tarifa completa de inscripción al campamento al enviar esta solicitud. Si opta por pagar más tarde, tenga en cuenta que su estudiante no estará completamente registrado en el campamento hasta que se haya recibido la tarifa de inscripción.

This fee is required to secure your student's place in camp. Please note that the $50 registration fee will be applied towards the balance of your total cost. This fee is non-refundable if you choose to no longer attend camp. // Esta tarifa es necesaria para asegurar el lugar de su estudiante en el campamento. Tenga en cuenta que la tarifa de inscripción de $50 se aplicará al saldo del costo total. Esta tarifa no es reembolsable.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

6/16/25

Contact information/Información del contacto:
Waniya Bryant
waniya@hopehorizonepa.org
main: 650.503.1440
front desk: 650.327.1139
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Welcome to Camp Hope Horizon East Palo Alto. Please submit the form below.

Camp Hope Horizon EPA -
06/16/2025 - 07/25/2025

Camp Closure Dates:
Thursday, June 19th, 2025
Friday, June 20th, 2025
Friday, July 4th, 2025

1001 Beech Street
East Palo Alto, CA 94303

Times:
Camp Hope Horizon
Monday through Friday:
8:00a - Student Drop- off
8:30a - 3:00p: Camp Hope Horizon
3:15p - Student Pick- Up

Fieldtrip Fridays (camp shirts are included in cost)

Cost:
$250 - total cost
$50 - non-refundable registration deposit

A camp Hope Horizon EPA staff member will contact you shortly with more information once payment has been made.
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Bienvenidos a Camp Hope Horizon East Palo Alto. Envíe el formulario a continuación.

Camp Hope Horizon East Palo Alto
Martes, 6/16/2025 - Viernes, 7/28/2025
1001 Beech St.
East Palo Alto, CA 94303

Fechas de cierre del campamento:
Jueves 19 de junio de 2025
viernes, 20 de junio de 2025
Viernes 4 de julio de 2025

1001 Beech St.
East Palo Alto, CA 94303

Veces:
Campamento Esperanza Horizonte
Lunes a viernes:
8:00a - Entrega de estudiantes
8:30a - 3:00p - Campamento Hope Horizon
3:15p - Recogida de estudiantes

Excursión: viernes (las camisetas del campamento están incluidas en el costo)

Costo:
$250 - costo total
$50 - depósito de inscripción no reembolsable

Un miembro del personal de Camp Hope Horizon EPA se comunicará con usted en breve para brindarle más información una vez que se haya realizado el pago.

Camp Hope Horizon Registration Summer 2025

Description

Please Fix the Following