Camp Diva's Winter Camp Orientation

Saturday, November 18, 2017, at 12 noon 

100 Buford Road , North Chesterfield, VA 23235



Registration Fee Waived for Each Additional Participant

(Sibling Discount - $35 off Weekly Enrollment)

Participant Information

Returning Participant *


Relationship to Participant: *
Additional Parent/Guardian Contact Info

Additional PARENT/GUARDIAN Information

Relationship to Participant: *

Medical Treatment/First Aid Authorization

I grant permission for the administration of First Aid to my child by the staff of CAMP DIVA, and those transporting my child to and from programs as their judgment deems advisable, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the parent/ guardian of the participant and emergency contact. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary for my child. *

Insurance Information

Transportation Consent

To insure the safety of your child, please list other adults to whom your child may be released to and transported by (MUST SHOW PROPER IDENTIFICATION)

Publicity/ Media Consent

Unless a letter to the contrary is received by CAMP DIVA, I give permission to use my child’s picture on the official Girls For A Change website, social media, in newspaper advertisements, or other publications.

Field Trip Transportation Consent

I hereby give permission for my child to be picked up and transported to the field trip location and returned to the camp location for field trips and other CAMP DIVA activities. *
I hereby give permission for my child to be picked up and transported to the field trip location and returned to the camp location for field trips and other CAMP DIVA activities. *
I hereby give permission for my child to be picked up and transported to the field trip location and returned to the camp location for field trips and other CAMP DIVA activities. *
You will be provided with a list of field trips and dates.

Liability Waiver

I, the undersigned parent or legal guardian, release CAMP DIVA, or any other person acting on their behalf, from liability for any bodily injury sustained and loss or damage of any personal article while on the premises or participating in any activity sponsored by CAMP DIVA. I also permit CAMP DIVA to seek medical treatment as deemed appropriate through EMS/911 and/or local hospitals. *

Code of Behavior Agreement

Must be read by Parent/Guardian and Participant

For Participant- You are representing yourselves, your family and community. We expect you will represent us well, and display mature and responsible behavior expected of respectable young ladies in society.

1. All participants are expected to demonstrate common courtesy and respect at all times. Inappropriate language/behavior will not be tolerated.

2. Participants should be modestly dressed. Writing on clothing should be respectful and positive.

3. The possession or consumption of any alcoholic beverage and/or possession/use of any illegal drug by an individual is not permitted.

4. Smoking is not permitted.

5. Weapons and/or drug paraphernalia are not allowed.

6. Prescription drugs need to be given to a staff member for storage and distribution.

7. Violation of these rules may lead to counseling, parental conference, or unfortunately, dismissal from the program. Camp Diva has a strict policy regarding the possession and usage of electronic devices (cell phones, mp3 players, etc.) and it will be discussed in more detail at orientation.

For Full-Day Parent/Guardian  All participants are expected to dismiss on time. A late fee of $5/minute will be assessed beginning at 6:05 p.m. If a child remains at the camp location beyond 6:30 p.m., the following calls will be made until a response is received. If an emergency arises that will delay pick up, we must be notified immediately and another person authorized to pick your child up must come.

1. A call to the parent’s workplace and/or home.
2. A call to those authorized to pick up the child.
3. A call to the emergency contact.
4. A call to the local police department and Child Protective Services.

CAMP DIVA will not permit parents or authorized representatives who are intoxicated to pick children up from our camp location. We do not wish to expose the location to any legal action for the improper release of children, but more importantly, we do not wish to expose the children enrolled in our programs to any danger resulting from their parents’ or authorized adult’s impaired faculties.  Therefore, we will expect our staff to be alert to the possibility of parental intoxication, and if there is evidence of such intoxication by means of speech, gait, or manner, that staff member will call a second staff member to corroborate. If both staff members agree that the parent is intoxicated, the staff will not permit transportation by that person, and the Richmond Police Department will be called to assist the program staff in determining the course of action to be taken.  If the parent insists on removing a child in spite of these actions, a conference will be held that week between the parent and the Director that could result in termination of the child’s participation in the program.

A parent of a child enrolled in the program who is not the child’s custodial parent will be permitted unlimited access to the camp location and be afforded the same rights as the custodial parent unless there is court documentation limiting access and contact by the non-custodial parent. This documentation must be on file in our office. Upon entering the camp location, the non-custodial parent must report to the director or designee in the child care office.

It is the intent of the CAMP DIVA program to provide all parents and guardians with an avenue for discussing and resolving any concerns they may have with regard to the care being provided by the center. When a concern has been identified, the parent should first discuss the issue with the program staff members. It is suggested that in order to facilitate the conversation, an appointment should be scheduled and the individual requesting the appointment should prepare a written list of pertinent discussion points prior to the appointment. Notes of what was discussed and agreed to during the meeting are also encouraged. Once the staff member(s) has/have addressed the issue, based on the response, the parent or guardian should consider the issue resolved. If the staff member was unable to address the issue because of its administrative nature, or if the parent or guardian is dissatisfied with the response or outcome, he/she should then discuss the issue with the Director. At that meeting, the parent or guardian should be prepared to discuss what has transpired to-date. The Director will research the issue and respond to the parent in a follow-up meeting, or at the initial meeting if no research is needed.

Camp Diva Winter Academy Registration Schedule

I understand that my obligation to pay the fees for Camp Diva Winter Academy is unconditional and that after payments have been made, no portion of fees paid or outstanding will be refunded or canceled in the event of absence, withdrawal or dismissal of the participant from summer camp. I agree to assume full responsibility for the fees agreed upon. I accept the rules and regulations of CAMP DIVA. *


General Behavior

Has your child experienced any of the following during the past year? (check all that apply)
Does she usually get her own way with other children?


Do you have a skill or talent that you are willing to share with CAMP DIVA participants? *

$25 Registration Fee and Camp Diva T-Shirt Purchase

I would like to Make a Payment *
Buy extra Camp Diva t-shirts $15 ea. How many would you like to order? 

I would like to Sponsor A Girl! Make your donation below

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