The D.O.O.R.S. Summer Camp Program. The D.O.O.R.S. Summer Camp Program.
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** Someapplicants may present with special behavioral needs requiring extraordinary supports. The D.O.O.R.S. Summer Camp Coordinator will consult with DDDC staff to asses manageability, and he/she will make every effort to recruit staff accordingly. Please be advised that there may be times when the nature of an individual’s needs may preclude him/her from participating in the camp experience due to an inability to recruit appropriately trained staff. If a child is unable to participate in the Camp program through Jaycee, DOORS may provide support for alternative camp options. Requests for alternative placements will be made on a case by case basis by the DOORS board.
Authorization to Release InformationPlease complete the followingas part of the admission process for DOORS-Camp Jaycee for summer 2012:Campers Name: ___________________________________________________ Date of Birth: _____________________Parent/Guardian’s Name: ___________________________________________Address: _________________________________________________________City: _________________________State:______ Zip: _________Phone (cell): __________________________________________E-mail:_______________________________________________Authorization for Exchange of InformationRelease of information, both written and verbal is requested explicitly for the purposes of the enhancement of your child’s psychosocial intervention and continuity of care while at camp. Obtained information will not be shared with any third party. It will also assist the DOORS Summer Camp Coordinator in determining staff assignments and ratios that best meet your child’s needs while insuring the safety of all.Restriction:This release of information may be revoked at any time by the signee. All revocations must be in writing and signed. …………………………………………………….I hereby authorize DOORS Summer Camp Coordinator to OBTAIN INFORMATION about my child from the DDDC Administration and Staff.DATE: _____________ Signature of the Parent: ________________________________Print Name: ____________________________________________________________DATE: _____________ Signature of Witness __________________________________Print Name: ____________________________________________________________Return to the DOORS Summer Camp Coordinator with application by June 10, 2012.
Financial Oversight for the D.O.O.R.S. Summer Camp Program