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Home
ISANA Main Page
Palmati Home
About
Our Staff
News
• News & Updates
• The ISANA Sun (Newsletter)
• Submit Pictures & Story Ideas
Careers
Resources
Bell Schedule
Community Partners
Meal Service
Monthly School Menu
Nutrition Assistance
Our School Culture
Parent Handbook
Powerschool
The ISANA Connection
ISANA Policies
Enroll Now
CALENDAR
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Camp ISANA At Palmati
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Camp ISANA At Palmati
Step
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16%
CAMP ISANA ATTENDANCE OPTIONS:
While completing the application you will be asked to designate a daily attendance option for your child. Your child’s enrollment and schedule for the duration of CAMP ISANA (June 26 – July 21) will be based upon your selection:
• Attendance Option #1: Monday – Friday 9am – 1pm
• Attendance Option #2: Monday – Friday 9am – 4pm
The Education Code states the intent of summer programs like the Expanded Learning Program is for students to participate in the program every day. Students must attend the program every day for the full range of hours selected to continue enrollment. Students are subject to dismissal from the program if these Program Attendance Requirements are not met.
Pick-up and Dismissal:
The program ends at 1:00pm each day for half day scholars and 4:00pm each day for full day scholars. If you expect to arrive late, please contact your child’s school as soon as possible.
Authorization for Student Pick-Up:
Parents/guardians may authorize additional adults to pick-up their child on the Authorization for Student Pick-Up Sheet. ISANA will not release students to individuals younger than 18 years old or to individuals who are not authorized by parents/guardians for pick-up on this form.
Email
*
I have read and understand all of the information above. I agree to follow of all these rules and help my son/daughter understand and follow the rules.
*
Yes
No
CAMP ISANA:
Our voluntary CAMP ISANA Summer Enrichment Program is offered through the Expanded Learning Department. CAMP ISANA will provide students with academic enrichment, physical and safety enrichment, social enrichment, a healthy lunch, and off site field trips. Students are supervised by highly trained and qualified ISANA staff.
• Please designate your child’s CAMP ISANA attendance option
*
Half Day: 9am – 1pm
Full Day: 9am – 4pm
Current Grade
*
Select a Grade
TK
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Student's Last Name
*
Student's First Name
*
Student's Middle Name
Existing ISANA Student?
*
Yes
No
StudentID
*
The same as Clever login (numbers only)
Student Date Of Birth:
*
MM slash DD slash YYYY
Sex
*
Male
Female
Shirt Size
*
Select a Size
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XXL
Ethnicity
*
American Indian/Alaskan Native
Asian
Native Hawaiian or Pacific Islander
Black/African American
Hispanic/Latino
White
Check all that apply
Student Info
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent / Guardian#1: First Name
*
Parent / Guardian#1: Last Name
*
Parent /Guardian #1: Relationship
*
Mother/Stepmother
Father/Stepfather
Aunt/Uncle
Godparent
Guardian
Foster Parent
Other
Parent /Guardian#1:Home Phone #
*
Parent /Guardian#1:Cell Phone #
Parent /Guardian#1:Work Phone #
Parent/ Guardian # 1: Email
*
Parent / Guardian #2: First Name
Parent / Guardian #2: Last Name
Parent /Guardian #2: Relationship
Mother/Stepmother
Father/Stepfather
Aunt/Uncle
Godparent
Guardian
Foster Parent
Other
Parent /Guardian #2: Home Phone #
Parent /Guardian #2: Cell Phone #
Parent /Guardian #2: Work Phone #
Parent/ Guardian #2: Email
Does the student have an IEP?
*
Make a selection
Yes
No
Does your child qualify for Free or Reduced lunch?
*
Make a selection
Yes
No
Court / Custody Orders
Is there a custody concern regarding this student?
*
Make a selection
Yes
No
Is there a current court order concerning this child?
*
Make a selection
Yes
No
Is the order still valid for this school year?
*
Make a selection
Yes
No
Sign-out Authorization
Individual #1: Complete Full Name
*
Individual #1: Relationship
*
Make a selection
Mother
Father
Grandparent
Aunt/Uncle
Godparent
Sibling
Guardian
Friend
Neighbor
Coworker
Other
Individual #1: Phone Number
*
Individual #2: Complete Full Name
*
Individual #2: Relationship
*
Make a selection
Mother
Father
Grandparent
Aunt/Uncle
Godparent
Sibling
Guardian
Friend
Neighbor
Coworker
Other
Individual #2: Phone Number
*
Individual #3: Complete Full Name
*
Individual #3: Relationship
*
Make a selection
Mother
Father
Grandparent
Aunt/Uncle
Godparent
Sibling
Guardian
Friend
Neighbor
Coworker
Other
Individual #3: Phone Number
*
Individual #4: Complete Full Name
Individual #4: Relationship
Make a selection
Mother
Father
Grandparent
Aunt/Uncle
Godparent
Sibling
Guardian
Friend
Neighbor
Coworker
Other
Individual #4: Phone Number
Individual #5: Complete Full Name
Individual #5: Relationship
Make a selection
Mother
Father
Grandparent
Aunt/Uncle
Godparent
Sibling
Guardian
Friend
Neighbor
Coworker
Other
Individual #5: Phone Number
Medical Information
Is the participant allergic to any medication(s)?
*
Yes
No
Please list medication(s):
Does the participant have any dietary restriction(s)?
*
Yes
No
If participant has dietary restriction(s) and/or has food allergies, please list restrictions:
Does the participant have any medications stored in the school office?
*
Yes
No
Please list medications
Parent/Guardian Acknowledgement
Parent/Guardian Acknowledgment:
By signing below, you agree to the following as parent/guardian of a child participating in the CAMP ISANA Program:
• I acknowledge there are risks inherent with my child’s participation in the voluntary CAMP ISANA, which may involve physical activities. On behalf of myself and my child, I voluntarily assume all risks and hereby release, waive, hold harmless, discharge, and covenant not to sue ISANA (including its Board, employees, officers, volunteers, instructors, and agents) from any and all liability, claims, actions, and demands for any cause of action arising out of, related to or in any way connected to any loss, damage, or injury that may be sustained by my child or to any property belonging to my child, arising from my child’s participation in the program.
• I understand ISANA reserves the right to cancel or change CAMP ISANA activities when necessary.
• I understand ISANA is not responsible for the loss or damage to my child’s personal belongings.
• In order to make each student’s participation a fun, safe and rewarding experience, we hold high expectations for student attitude and behavior. I agree that my child must follow ISANA’s conduct and disciplinary rules. (same rules that apply during the school day)
I hereby perpetually and irrevocably grant to ISANA the right, permission, and license to record my child’s likeness and/or voice during CAMP ISANA activities with still photography, film, videotape, digital recording or storage device and to edit such recordings at ISANA’s discretion, and to use, reproduce, display, and/or distribute, and/or to make derivative works, with or without the pupil’s name, from the recordings for educational, promotional and fundraising purposes
*
Yes
No
I authorize my child to be released to those individuals listed on this registration form at the close of each program day and in case of emergencies. I understand that my child must be signed out by a parent/guardian or approved adult who is 18 years or older and are listed on this registration form.
*
Yes
No
I understand that in case of emergencies, CAMP ISANA will make every effort to contact the parents/legal guardians before any treatment is given. In the event that we cannot be contacted, I hereby authorize the physician or hospital selected by CAMP ISANA hospitalize, secure treatment for and to order injection, anesthesia, or surgery for my child. It is further understood that I will assume full responsibility for any such treatment, including the payment of all costs and transportation and will hold the CAMP ISANA Site Coordinator and After-School Staff, harmless therefrom.
*
Yes
No
I agree to the terms, guidelines, and conditions of the program's Code of Conduct.
*
Yes
No
I have read this release of liability and assumption of risk agreement, I fully understand its terms, I understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.
*
Yes
No
I have read all the above and agree to all terms and conditions of my child's participation in the program. I confirm that all the information above is accurate and will provide and updated Student Registration Form if any information changes.
*
Yes, I have
TYPE FULL LEGAL NAME BELOW
*
Email
This field is for validation purposes and should be left unchanged.
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