Welcome to Chinmaya Mission Sacramento Center

Please note the following
This page allows you to register a single child to the Chinmaya Sacramento Summer Day camp. If you are enrolling more than one child use separate registrations. Fees are as follows for the camp

1st child (family registered in BalaVihar): $300
Each additional child from family (family registered in BalaVihar): $250
1st child (family not registered in BalaVihar): $350
Each additional child from family (family not registered in BalaVihar): $300

RM_Stats

Camper First Name

Camper Last Name^*

First name of Mother

First Name of Father^*

Parent Last Name^*

Date of Birth of Camper^*

Camper Grade^*

Address

Phone Number^*

Mobile

Email^*

Alternate Email

MEDICAL INFORMATION (if any, we need to know):

Any food restrictions or allergies^*

PHYSICIAN (Name/Tel)^*

HOSPITAL AFFILIATION:^*

MEDICAL INSURANCE PROVIDER^*

MEDICAL INSURANCE PROVIDER Telephone number^*

SUBSCRIBER NAME^*

GROUP/POLICY #^*

Please list two (2) people to be contacted in case of emergency. (Please make them aware that their name will be used.) We will make every effort to contact the parent first, then your emergency contacts.

Emergency Contact #1^*

Emergency Contact #1 Relationship^*

Emergency Contact #1 Phone number^*

Emergency Contact #2^*

Emergency Contact #2 Relationship^*

Emergency Contact #2 Phone number^*

My child may be released to the following adults only (picture ID is required).

Pick-up contact #1^*

Pick-up contact #1 Relationship^*

pick-up contact #1 Phone number^*

Pick-up contact #2^*

Pick-up contact #2 Relationship^*

pick-up contact #2 Phone number^*

Read and accept #1^*

I give full permission for my child in my care to attend and participate in all camp activities

Read and accept #2^*

I agree to cooperate with all regulations

Read and accept #3^*

I understand to pay the fees in full at time of registration

Read and accept #4^*

I give full permission for Chinmaya Mission of Sacramento to use any photographs, films and/or sound recordings in which my child appears for publicity purposes, now and any time in the future, in any media

Read and accept #5^*

Emergency Medical Release In case of an emergency, I understand every effort will be made to contact me or the emergency contact persons listed above. In the event that we cannot be reached, I hereby give permission to Chinmaya Mission Staff/Volunteer or the physician listed on the form to hospitalize, secure proper treatment and to order anesthesia or surgery for my child, including calling 911. I understand Chinmaya Mission Sacramento is not responsible for cost of medical care. I also release the Chinmaya Mission Sacramento from any and all liability related to medical treatment.

Read and accept #6^*

I hereby release and discharge said Chinmaya Mission Sacramento and any and all agents from any liability, claim, cause of action, demand or damages from injury or damages of any kind to my child or my property as a result of participation in the youth program

Read and accept #7^*

I ACCEPT ALL THE TERMS AND CONDITIONS OF THE CAMP

Registration Fee^*

Choose PayPal option to pay online even if you do not have a PayPal account and want to pay using a credit card. A PayPal account is not necessary to pay online.

Select a payment method^*

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