Creative Industry Residential Camp 2019



To be eligible for this experience a complete payment of 1,000 plus a 3.5% service fee must be made by June 1st.

Payments can be made via paypal or in person with a credit card, you must make an appointment to pay in person.

Creative Industry Orientation for paid registrants only

Saturday, June 15, 2019, at 10:30 am

100 Buford Road, North Chesterfield, VA 23235




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 Girls For A Change, 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)

Consent & Agreements

Unless a letter to the contrary is received by Girls For A Change, 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. *
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 Girls For A Change activities. *
Cancelation/Refund Policy: I understand that $100.00 of my payments will be refunded if I cancel more than 20 days before camp, no refund if I cancel within 1 day of camp. If I request a refund, the returned check will NOT be issued until the week after the Creative Industry Camp. *
Payment Plan Policy: Late Fee of $25 per participant Initial I understand that the Payment Plan Policy states that payments must be made on or before the close of the said business day listed If payments are not received on or before the due date and/or are not the correct amount a late fee of $25 will be assessed to your account. If a check is returned to us for any reason, there will be a Non-sufficient funds (NSF) fee of $20 and the payment will be considered late. Once the late fee is assessed, you will have five (5) days to remit payment plus a late fee. *
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. Girls For A Change 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.


Overnight trips are a privilege, and participating girls are expected to behave in a manner that best represents Girls For A Change, Richmond, VA, family and the participant. A Counselor /administrator will be called immediately in cases of inappropriate behavior. Violations of these rules, the Girls For A Change Code of Conduct, or any applicable Extracurricular Code of Conduct may result in a participant being sent home at her parents’ expense, ineligibility for future programs, suspension from extracurricular activities planned, and/or any other disciplinary action authorized by the Code of Conduct.

In order that everyone may receive maximum benefits from participation in school trips, these rules will be enforced at all times. Furthermore, all requirements of the Code of Conduct and any Extracurricular Code of Conduct will be enforced at all times during the trip.

1. Participants will be on time and prepared for leaving on school transportation. Students will remain on/in assigned buses/van/cars and may not switch among vehicles without permission.

2. Valuables should be left at home. Girls For A Change staff members are not responsible for personal items.

3. All luggage and personal belongings may be searched prior to being loaded for the trip and at any time during the trip if an administrator or staff has reasonable suspicion that the item contains prohibited items of any kind.

4. If passes or ID badges are provided, students must wear them at all times while on the trip. T0 shirts also must be worn when requested. 

5. Participants will wear appropriate attire as defined by the school dress code or as deemed appropriate for the activity by the sponsor.

6. Participants will follow the instructions of the sponsor, guest or, Girls For A Change staff, adult chaperones at all times.

7. Participants will attend (on-time) all sessions and activities to which they are assigned during the trip.

8. Participants will not deface or otherwise damage property. Any damages to property or furnishings will be paid for by the individual student and/or his or her parents.

9. Participants must keep the sponsor informed of their activities and whereabouts at all times; students may not leave the hotel without sponsor permission.

10. At hotel check-in, movie and game privileges will be turned off in student rooms. They may be re-instated only by sponsor authorization and only after students have made payment for movies, etc. Participants can not charge any phone calls or room service to their room. Any evidence of these action will be charged to the parents/guardian. 

11. Participants will spend the night or nights at the assigned hotels in the assigned room(s). Except in the case of emergency or permission from the sponsor, students will remain in their rooms after curfew. 

12. Participants must be in their assigned rooms and quiet at the curfew set by the sponsor. At meetings, participants may be asked to turn off their cell phones. Misuse of cell phones or other electronic devices is subject to the same disciplinary consequences as outlined in the code of Conduct.

13. Unless there is an emergency, students may not use hotel telephones without Girls For A Change approval. At check-in, long-distance capabilities will be turned off in participants rooms.

14. Students will not be permitted at any time (day or night) to be in sleeping rooms with members of the opposite sex, sharing beds or engaging in sexual activity with anyone.

15. Girls For A Change activities and trips are to be tobacco-free, alcohol-free, drug-free, and weaponfree. Students are prohibited from possessing, using, or conveying alcoholic beverages, illegal drugs, prescription drugs not prescribed to the student, tobacco products, and weapons on school trips. The presence of any of the items listed above in a student’s luggage, personal effects, or hotel room may be considered to be possession of the item, regardless of whether the student actually uses the prohibited substance or weapon.

16. Participants will neither open hotel windows nor hang/throw objects out of hotel windows or balconies.

17. Participants will be quiet and considerate of other guests in hotels or at gatherings.

18. Buses are to be clean and free of trash at the end of all trips.

19. At the end of all trips, participants will arrange to be picked up at site promptly at the designated time.We have read, understand, and agree to abide by the rules pertaining to all trips.

20. We 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’  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.

21. 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.

22. It is the intent of the  Girls For A Change 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.


We understand that any violation of these rules, or any other misconduct, may result in the student being sent home immediately at the parents’ expense, as well as other disciplinary consequences as described above. *


General Behavior

Has your child experienced any of the following during the past year? (check all that apply)
Has your daughter stayed away from home with no family members for over three days at one time.


Do you have a skill or talent that you are willing to share with Girls For A Change participants? *
Are you interested in a scholarship, if so please enter the amount below. Options are 750, 500, or 250 dollars. You must also complete a scholarship form located on our website. *

Payment 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? 🛈

Donations are greatly appreciated!

Sponsorship 🛈
Current Total: