Elmy's New Jersey Summer Camp Registration Form

We welcome all our new campers to our 2024 Summer Day Camp program. We are delighted to have you join us this year and look forward to having a safe and fun-filled Camp experience.

To best support you in the registration process, we’ve designed this checklist to help you organize what you need to enrol in our Day Camp program successfully. Below are some important facts and dates.

Financial Support toward Summer Camp Tuition – Deadline June 30, 2025

As with all services provided through CSOC, Summer Camp Services are based on available resources in a given fiscal year. The Financial Support toward Summer Camp available per youth is limited to a specific amount.

In addition, Financial Support may vary by year and by the number of families that apply. CSOC Financial Support toward Summer Camp Tuition should be a last resort. Families and caregivers are encouraged to look for tuition help from other sources, such as local recreation departments, local civic groups, and asking camp providers about scholarship.

CSOC will provide Financial Support toward Summer Camp Tuition only for camps on the Qualified Camp list. Since CSOC Financial Support toward Summer Camp Tuition is not guaranteed, families/caregivers should consider their financial ability to pay the balance that exceeds the CSOC tuition cap. Families/caregivers are responsible for the cost of summer camp tuition minus any financial support provided by CSOC.

Q. Is there a deadline to apply for Financial Support toward Summer Camp Tuition?

Yes. Your application must be complete and postmarked/received no later than June 30, 2024 to be considered for financial support. Applications will not be accepted after the June 30 deadline.

Q. Who is eligible for CSOC Financial Support toward Summer Camp Tuition?

A youth is eligible for CSOC Financial Support toward Summer Camp Tuition if:

The youth is deemed eligible for CSOC developmental disability (DD) services.

The youth is under the age of 21 and will not turn 21 before the end of the camp dates selected for reimbursement.

The youth resides at home with a caregiver.

Youth are eligible for CSOC Financial Support toward Summer Camp Tuition only during the period of time in which they are not eligible to attend an extended school-year program.

How to apply for Financial Support toward Summer Camp?
Families can apply for Financial Support either online or through a paper application. To apply for ARS, please contact PerformCare at 1-877-652-7624 to request ARS for your child.

PLEASE ENSURE YOU HAVE YOUR CHILD'S CYBER ID NUMBER BEFORE APPLYING.

The family or caregiver must register the youth with the CSOC Qualified Camp before starting the Application for CSOC Summer Camp Services (Part A - Financial Support toward Summer Camp Tuition). Your child must be determined eligible for Developmental Disability services by CSOC, and your camp selection must be from the CSOC Qualified Camps list.

Important Dates to Remember

Day Camp Session Dates:

Session: 7/5-8/31

Please note, that each child/youth is only authorized for up to 10 days by NJ Children’s System of Care (CSOC) and can only begin based on the individuals authorization.

Things to Remember

Lunch: Families MUST provide lunch or lunch money.

Sun Safety: hats/caps and sunscreen.

Medical Forms: Medical forms must be completed by a physician and include a signature and stamp. Medical forms must be submitted by 6/26.

Financial Assistance: CSOC, Summer Camp Services-Deadline June 30, 2025.

Important Facts

Direct Support Professionals: All DSP’s/Elmy’s staff must go through a prescreening process before they can come into our programs and interact with our campers. Our screening process includes a background check and a drug test, and orientation training. Please note, without clearance, they will not be able to provide services during our Camp program.

Grouping Requests: Based on need and assessment some individuals may be approved 1 to 1 staffing. Please note, our traditional Day Camp is broken up by age, so children/youth must be the same age range and registered in the camp program.

Thank you for choosing our Elmy’s NJ Summer Camp. We look forward to getting to know your camper!

IMPORTANT: It is necessary for you to have your child's Cyber ID number and have achieved eligibility for Developmental Disabilities through PerformCare.

In order to get your child's Cyber ID Number, and be deemed eligible, please follow the steps below:

Call 877 652 7624
Register with PerformCare and achieve DD-eligibility
Get the Cyber ID number to confirm service eligibility

Please ensure you have completed and possess all the required documentation in order to apply for Elmy's Summer Camp.

Has eligibility for DD-services been achieved through PerformCare?

Child's Cyber ID Number *

Participant Info

Child’s Name *

Date of birth *

Gender

School *

Grade in September 2024 *

Mailing Address

Street *

City/Suburb

State *

Zip/Post Code *

County *

Email Address *

Childs Diagnosis *

Describe your childs behaviours *

What T-Shirt size is your child? *

Child

Adolescent

Parent/Guardian Info

Name of Parent/Guardian registering child *

Work Phone *

Cell Phone *

Email Address *

Name of 2nd Parent/Guardian

Work Phone

Cell Phone

Email Address

Emergency Contact Info

Please list two (2) contacts not already listed on this form if the Parents/Guardians relation cannot be reached.

Name *

Work Phone *

Cell Phone *

Name

Work Phone

Cell Phone

Physician Info

Name *

Work Phone *

Address

Street *

City/Suburb

State *

Zip/Post Code *

Country *

Authorization/Consent

EMERGENCY AUTHORIZATION: I understand that in the event of an emergency affecting my child while participating in a Elmy’s program, a designated employee of the Elmy’s will attempt to contact me and inform me as soon as possible. In the event I cannot be reached, I hereby give permission for my child to be treated or hospitalized by a licensed physician or hospital selected by the Elmy’s Special Services, Inc.

Parent/Guardian’s Name *

Parent/Guardian Signature *

Clear

I consent for emergency authorization.

Participant’s Name *

Date *

Permission Form

I hereby grant permission for my child to participate in all activities of Elmy’s NJ Summer Camp.

I hereby grant permission for my child to participate in field trips, under proper supervision of Elmy’s staff, for park activities and field trips. It is my understanding that these trips will be taken over the camp session without further consent from me.

Parent/Guardian’s Name *

Parent/Guardian’s Signature

Clear

I consent for the permission form.

Participant’s Name *

Date *

Authorized Pick-up Form

The following individuals are 16 years old or older and are allowed to pick up my child from the Elmy’s Summer Camp Program. Those authorized to pick up your child will be asked for photo ID for verification.

Individual 1

Name *

Relationship *

Phone Number *

Individual 2 (optional)

Name

Relationship

Phone

I understand that no one else will be allowed to pick up my child unless I notify Elmy’s staff in advance and in writing. This person will also be asked for their photo ID for verification.

Arrival & Sign In Procedures

I understand that my child must be escorted into the building and a parent/guardian must sign the child in at arrival.

Parent/Guardian Signature

Clear

I consent for child must be escorted into the building.

Date *

Escorted Dismissal Authorization

I understand that my child must be picked up no later than 3:30 PM at t the end of the day.

I Understand

Parent/Guardian Signature

Clear

I consent for child must be picked up not more than 3:30.

Date *

Agreement

I, the undersigned, give permission for my child to participate in Summer Camp. I am aware that a completed medical form signed by a physician is required before my child may begin Summer Camp. I understand that enrollment is based on CSOC authorization. Lastly, I fully understand that my child will participate in field trips and activities. I have read, signed, and agreed to the registration requirements.

Parent/Guardian Signature

Clear

I consent on giving permission for my child to participate in Summer Camp

Parent/Guardian Signature Date *

Standard Release Form

From time to time, Elmy’s Special Services, Inc II (the “Elmy’s NJ”) takes pictures or records videos of individuals participating in Elmy’s NJ programs, using its facilities, or attending one of its special events. Additionally, Elmy’s NJ may permit members of the media (the “Media”) to take such pictures or record such videos in order to promote Elmy’s NJ’s charitable mission and for other mission purposes.

The individual person named below is signing this Release for the purposes of allowing the Elmy’s NJ and the Media to use one or more such photographs, video recordings, and/or sound recordings (collectively, “Recordings”) of such person for any purpose consistent with the Elmy’s NJ’s charitable mission, which includes, but is not limited to, the Elmy’s NJ or the Media publishing such Recordings in newspapers, newsletters, flyers, brochures web sites, and other print or electronic publications, on television, or on the radio. By signing this Release, such person acknowledges that he or she has freely consented to be photographed, filmed, or otherwise recorded and has signed this Release of his or her own free will. If the person named below is under age 18, a parent or guardian of such person must sign on such person’s behalf.

1) I agree that I am willing to be photographed, filmed, or otherwise recorded by Elmy’s NJ, its contractors, and the Media, either individually or as part of a group Recording, which may include my image, likeness, and/or voice. I further agree that my name may be used to identify me as a subject of any Recordings featuring my image, likeness, and/or voice.

2) I understand that Elmy’s NJ will own all rights in the Recordings of me that Elmy’s NJ or a Elmy’s NJ contractor takes or records (“Elmy’s NJ Recordings”), and that Elmy’s NJ will have the exclusive right to use, or allow others to use, such Elmy’s NJ Recordings in any medium for any purpose consistent with the Elmy’s NJ’s charitable mission as determined by the Elmy’s NJ.

3) I understand that the Media will own all rights in the Recordings of me that the Media takes or records (“Media Recordings”), and that the Media will have the exclusive right to use, or allow others to use, such Media Recordings in any medium for any lawful purpose.

4) I understand that I am waiving any and all rights that may preclude Elmy’s NJ’s or the Media’s use of the Recordings as described above.

5) I acknowledge that neither the Elmy’s NJ nor the Media has any obligation to use any Recordings of me or to use such Recordings for any particular purpose.

6) I understand that I will receive no monetary payment or other compensation in exchange for the rights to use Recordings of me.

Participant’s Name (printed) *

Name of Parent/Guardian *

Parent/Guardian's Signature

Clear

I consent on the use of childs photograph or video.

Date *