Summer Camp Paperwork

Below is IC3's Summer Camp registration form and you will be required to make payment to secure your child's space. **ANY CHANGES TO CAMP REGISTRATION MUST BE REQUESTED USING THE SUMMER CAMP CANCELLATION REQUEST FORM. If you have any questions regarding IC3 Summer Camp please call 607-257-0200.

I, being the parent or legal guardian of the above-named child, know that I may not be available to authorize medical, dental, surgical care and/or hospitalization for my child while s/he is attending Ithaca Community Childcare Center, and I wish to appoint someone to act in my absence and to give such authorization. This authorization is intended to give Ithaca Community Childcare Center staff the right to give consent for emergency diagnostic medical, dental, surgical procedures and hospitalization, and which the physician, dentist, or hospital personnel in said persons' judgement may deem advisable. I have attached the important medical facts pertaining to my child, if any, and/or explained in the About The Child section of this form. These faces are intended to assist medical personnel in deciding what treatment is to be given. It is in no way intended to restrict the giving of authorization or consent by the person(s) named herein. Ithaca Community Childcare Center (IC3) Personnel: 579 Warren Road, Ithaca, NY 14850 607-257-0200

REMINDER: CAMP HOURS ARE 9:00-5:30 PM. Registration is on a first come, first serve basis. **Any changes to camp registration must be requested utilizing the Summer Camp Request to Change Form in writing.