After School | Camp Fire

Name*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Gender*

Date of Birth*

Grade Level*

School*

Membership Status*

Email*

Ethnic/Racial*

Total # in Family*

Receive Free/Reduced Lunch at School*

Handicaps/Disabilities*

Hearing Impairment
Learning Disabled
Visual Impairment
Orthopedic
Intellectual Disability
None

List specific activities your child should not participate in*

List allergies or physical/health limitations*

Physician's Name

Physician's Phone

Do you work for the government or are you involved with the military?*

No
Yes

Father or Guardian's Information

Name

First Last

Employer

Work Phone Number

Occupation

Mother or Guardian's Information

Name*

First Last

Employer*

Work Phone Number*

Occupation*

Emergency Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship*

Operational Changes due to COVID-19*

Camp Fire North Texas is also facing new requirements to ensure the safety of our youth, staff, and all of their families. With the current health concerns, we are having to make some changes to our pick up at the schools and operations at Harrell Park.
Temperature checks will be implemented prior to children getting on the van. If a child has a 99.5°F temperature or higher, they will not be allowed on the van and will be sent back with the teacher.
We will be limiting the number of children that can register from each school. This will allow us to put fewer children on the van together and allow for smaller groups while at the park. We currently can only have eight children per van. This limit means that all children must be registered either in our office, 2414 Ninth St, or through our website, campfirentx.org. In the past, we have allowed children to turn in forms at the vans or for parents to turn in forms at the schools. These will no longer be accepted. We hate to turn anyone away, but since we are limiting the number transported, we must have forms turned in through the office to adhere to these limits.
Masks will be required on the vans and while at the park, except during meal times. Weather permitting, we will be serving meals both inside and outdoors to help limit the number of children sitting together at the tables.
Our GMM building will be utilized as an infirmary if a child becomes ill. Any child that exhibits symptoms of illness (such as cough, fever, chills, sore throat, difficulty breathing, nausea, vomiting, diarrhea, etc.) will be brought to the GMM for isolation and monitoring. Parents will be called to pick up the child as soon as possible. The Lodge, our primary building, will be closed off and disinfected. If a child that has been at the park has been reported as lab-confirmed to have COVID-19, we will contact the local health department and notify all parents. Likewise, if a staff member is lab-confirmed to have COVID-19, we will contact the local health department as well as all parents will be notified.
All buildings, vans, and equipment will be disinfected daily. High touch areas will be disinfected throughout the afternoon. Staff and children will be encouraged to practice frequent hand hygiene through use of hand sanitizer and hand washing.
** With the current pandemic, dates are subject to change. We will notify all members via the provided e-mail address on the registration forms, phone calls, and social media. We will also notify the schools if we will be closed for any reason. We ask that all parents provide an up-to-date email address, as this will be an important form of contact in the event of a closure. **

I have read and understood the updated operational changes at Camp Fire North Texas

Signature Acknowledging Operational Changes*

TRANSPORTATION CONSIDERATIONS*

Please make every effort to pick your child up from the school at 6:00 pm.
If necessary, Camp Fire vans can transport children home if arrangements cannot be made to pick them up at the school at the end of the day. Take homes do not start until all other children are picked up from the vans at the school. Please allow extra time for this.

My child will be picked up at the school
My child will need transportation home (to the home address listed)

PARENTAL PERMISSION*

Yes, You have my permission to use photographs in which my child (or ward) appears for Camp Fire publicity.

I give my permission that my child (or ward) become a member of Camp Fire North Texas . I will observe the rules of the council and I will waive any claims against Camp Fire North Texas except for claims arising from gross negligence or willful acts of the council or its agents that may arise from participation in the activities of the Camp Fire North Texas. I understand that reasonable measures will be taken to safeguard the health and safety of all participants and that I will be notified as soon as possible in case of any emergency affecting my child (my ward). In the event I cannot be reached in an emergency, I hereby authorize the calling of a physician to provide whatever emergency medical or surgical treatment is necessary. I accept responsibility for the cost of such medical treatments. My child (or ward) has my permission to attend and participate in all Camp Fire activities at Harrell Park, including swimming, skating, canoeing, and field trips outside of Harrell Park with proper staff supervision.
I understand that any information relating to my child (medical, limited physical activity, return to his/her school) will be communicated to office personnel (not van drivers) by calling 322- 5209 before 2:00 pm.
Children will be released from the vans only when the driver acknowledges the parent's arrival. Children who are not picked up in a timely manner upon their return to school, and after every effort has been made to contact an adult (using contact numbers provided to Camp Fire) will be taken to the Children's Aid Society located at 1101 30th Street. Their telephone number is 322-3141. If your child needs to be taken home by the Camp Fire van, the van will take the children to the school first, and then children will be taken home. Please allow extra time for this.
*Disrespect and/or violent behavior toward anyone at any Camp Fire event, activity, or function may result in the permanent expulsion of my child (or ward) from all Camp Fire activities in the future. This includes behavior on the vans.

Parent/Guardian Signature*

Date*

Monday	Tuesday	Wednesday	Thursday	Friday
Scotland Park	City View	Washington	Zundy	Kate Burgess
Lamar	Fain	Haynes	Ben Franklin	West
Tower	Fowler	Southern Hills	Crockett	Jefferson
Sheppard	Milam	Scotland Park		Barwise
	Cunningham			Kirby
				McNiel