West Side Helping Hand

Camper Enrollment Form

All fields marked with an asterisk are required. Your progress is not saved, so please complete the form in one sitting.

Camper Information

Campers Full Name *

West Side Helping Hand requires parents to submit camper’s report card every six weeks. This requirement is mandatory for your child to continue enrollment in the West Side Helping Hand youth program.

Parent/Guardian Signature *

Date *

Transportation Authorization Form

School *

Participant’s Name *

Date of Birth *

Home Address *

City/State *

Zip Code *

Parent/Guardian Signature *

Cell Phone *

Email Address *

Is West Side Helping Hand ALLOWED to transport your child(ren) in a vehicle? *

Yes No

Parent/Guardian Signature *

Date *

Release of Liablity

Waiver & Release

I, guardian of above student, have received and read the CDC Texas Minimum Standard Health Protocols provided by West Side Helping Hand.

WSHH continues monitoring for symptoms:

*Fever
*Cough
*Body aches
*Shortness of breath

For safety reasons WSHH continues protocol: Parents are not allowed inside during camp hours.

I HEREBY AKNOWLEGDE THAT IN THIS WAIVER AND RELEASE, I AM WAIVING AND RELEASING CLAIMS OF NEGLIGENCE AGAINST WEST SIDE HELPING HAND AND ITS EMPLOYEES, VOLUNTEERS, STAFF, AND REPRESENTATIVES THAT MAY RELATE IN ANY MANNER TO ANY INFECTION OF CORONA VIRUS/COVID-19 BY ME OR MY CHILD, I FURTHER ACKNOWLEGDE THAT THIS PROVISION IS CONSPICUOUS.

I have read and agree to the Waiver & Release. *

Informed Consent and Acknowlegment

I further understand that I hold West Side Helping Hand, its directors, employees, agents, and volunteers harmless from any and all liability or claims which may arise from my child’s participation in West Side Helping Hand.

I have read and agree to the Informed Consent and Acknowlegment. *

Youth Program — Registration Form

Full Name *

Age *

Date of Birth *

Gender *

Male Female

School *

Grade *

Parent/Guardian Full Name *

Home Address *

City/State *

Zip Code *

Cell Phone *

Work Phone

Email Address *

Student Release and Pick-Up Infromation

Authorized person 1 (required)

Name *

Relationship *

Phone *

Authorized person 2 (optional)

Name

Relationship

Phone

Authorized person 3 (optional)

Name

Relationship

Phone

Parent/Guardian Signature *

Date *

Medical Emergency Contact Information

Name *

Relationship *

Phone *

Does Your Child Have Medical Insurance? *

Yes No

If YES, what is the policy, if no, type “none”? *

Any Allergies? If no, type “none” *

Any Special Needs? If no, type “none” *

List All Medications Your Child Takes? Type “none” if no medications. *

In Case of Emergency

If I am unable to be reached in case of emergency involving my child, I give my permission for West Side Helping Hand Staff to act as guardian and seek emergency medical treatment.

I agree. *

Release of Liability, Informed Consent and Acknowledgement

Program Consent

I, the parent of above child, hereby grant permission for my child to take part in all programs and activities facilitated by WSHH and to be included in photographs, and videos used for social media, newsletters, and advertisement. WSHH is a non-profit organization, and our funders often request phots and videos. Please be advised we will post such events on our social media page.

I grant permission. *

Policy and Procedures

Campers Full Name *

DROP OFF PROCEDURE:: Parent/guardian must sign in child with WSHH staff (Must attend 3 days weekly)
PICK UP PROCEDURE:: Parent or authorized person must sign child out with WSHH staff. It is WSHH's policy to ask for ID when in doubt.
PICK UP POLICY:: Please contact WSHH if arriving late. WSHH reserves the right to replace any camper who is consistently picked up late. (3 or more late pickups)
MEDICATION POLICY:: Medications must have the prescription label attached to the container.
UNACCEPTABLE BEHAVIOR:: Includes but not limited to: Inappropriate or violent physical conduct- disrespecting others and their spaces-failure to comply with staff members' directions. Incidents will be recorded and reported to parent.
DOCUMENTATION PROCEDURE:: WSHH requires parent and camper signature to be included on the Campus Behavioral Report Form. After 3 recorded incidents WSHH reserves the right to replace such camper. HOWEVER: If the behavior is severe, WSHH has the right to remove camper immediately.
CELL PHONE POLICY:: Cell phone recording, taking pictures, using inappropriate websites or apps, are not allowed on premises. No cell phone usage is allowed during rotations. If camper is caught violating cell phone policy, that camper will lose cell phone privileges.

Agreement

WSHH is not responsible for loss or damage of any device brought to campus.

I have read and agree with all WSHH’s policies and procedures.

I agree. *

Handbook Agreement

I have read the WSHH parent handbook and agree with all its policies and procedures. Handbook can be downloaded HERE

I agree. *

NOTE: IF your child requires medication you will need to fill out the “AUTHORIZATION FOR DISPENSING MEDICATION” form. You will be redirected automatically to the correct form after hitting “Send” on this page.

Required fields are marked with an asterisk.