Camp Little Marvels (Camp LM) Registration Form for Summer 2025

Camp Little Marvels (Camp LM)
Registration Form for Summer 2025

773-472-3045

camp@littlemarvelspreschool.com

3045 N. Lincoln Ave. Chicago, IL 60657
Child's Information:
Child's Name*

First NameLast Name
Birthdate:*

MonthDayYear
Date
Current Age:*
*Participants must be between the ages of 5 (by September 1st) and 11 years old

Parent / Guardian 1:*

First NameLast Name
Relationship to Child:*
Cellular Number:*
Email:*
example@example.com
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number:
Work Number:

PARENT/GUARDIAN 2:
Parent / Guardian 2:

First NameLast Name
Relationship to Child:
Email:
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cellular Number:
Home Number:
Work Number:

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Sibling 1	Quantity	Price
First Child		$450.00
Sibling 1		$400.00
Sibling 2		$400.00
Sibling 3		$400.00

Dismissal / Authorized Child Pick-Up Information:

The following individuals are authorized to pick up my child:
Authorized Person 1:

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.

Authorized Person 2:
Authorized Person 2:

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.

Authorized Person 3:
Authorized Person 3:

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.

Emergency Contact Information
Emergency Contact 1:*

First NameLast Name
Relationship to Child:*
Phone Number*
Please enter a valid phone number.
Emergency Contact 2:

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.

ADDITIONAL INFORMATION (Important information we should know about your child):
Medical:
Social / Emotional:
Does your child require a special diet or have any food allergies?*

YesNo
If yes, please explain:
Does your child have any non-food allergies?*

YesNo
If yes, please explain:
Does your child require an Epi-pen?*

YesNo

MEDICAL DISCLAIMER:

Little Marvels will not have medical personnel on staff. We will closely be following the updated health and safety guidelines set forth by both the CDC and Illinois Department of Health (IDPH). We will be adhering to any protocols and best practices in accordance with the guidelines for our programs to ensure the ongoing safety of all children and staff. Dependent on the most updated guidelines, these may include but are not limited to:

● Children will be screened for signs of illness prior to being admitted into our facility.

● Surfaces will be cleaned and sanitized throughout the day.

In the event that a child complains of feeling ill or displays symptoms of illness, the parent/guardian or emergency contact will be called and asked to pick up their child as soon as possible. If a child complains of feeling ill or displays symptoms of illness at home, please do not send your child to Little Marvels until they have been symptom free for at least 24 hours without the aid of medication.

In the event of a minor cut or injury, a member of our staff will administer basic first aid (i.e. apply ointment, bandages, and/or an ice pack if necessary). In the event of a severe injury or medical emergency, a staff member will call 911 immediately, followed by a parent/guardian being notified. Little Marvels’ staff will not administer any medication to children unless required by a doctor’s note.
Initial*

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PERMISSIONS:

I hereby give permission for my child to participate in all program activities. Permission is granted to Little Marvels to take my child on trips outside as part of the regular camp program. Little Marvels does not transport children in vehicles.

I hereby give permission for photographs and videos to be taken of my child. Little Marvels has the right to utilize these in camp brochures and displays, as well as other mediums including, but not limited to, electronic, video and print. Children’s names will not be used.

I have read and agree to all terms, conditions and permissions on the enrollment application.
Parent Full Name:*

PrefixFirst NameMiddle NameLast NameSuffix
Signature*

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Signing Date*

MonthDayYear
Date

CODE OF CONDUCT:

Little Marvels is dedicated to providing an outstanding program and the best possible experience for your child. To accomplish this goal, children are expected to behave appropriately and promote a safe, fun, and healthy environment through productive participation. We aim to promote character values of caring, honesty, respect, and responsibility in all aspects of our programs. We ask that all participants and their parents/guardians read the following expectations together and sign before arriving at camp or other program.

Children are expected to:

● Cooperate and contribute positively to the experience of fellow campers/participants

● Show respect to the staff and cooperate fully with their instructions at all times

● Not engage in behavior which would endanger the health, safety, or well-being of any child, staff member, or themselves

● Conduct themselves responsibly, understanding that horseplay, teasing/bullying or other unkind or inappropriate behaviors will not be tolerated

We do not have the ability to dedicate the full attention of a single staff member to only one participant. If it becomes apparent that a child requires individual supervision because of their behavior or any other issues, this compromises our ability to care for that child and the rest of the children. The program experience is for ALL children, and if a child's behavior is deemed to be outside the expectations and/or unmanageable, any of the following may be a result:

● Verbal counseling from our staff

● Timeout from scheduled activities

● Parent/Guardian conference

● Dismissal from the program

I have read and agree to all terms of the code of conduct.
Parent Full Name:*

PrefixFirst NameMiddle NameLast NameSuffix
Signature*

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Signing Date*

MonthDayYear
Date
Please verify that you are human*
Calculation
Should be Empty:

Camp Little Marvels (Camp LM)

Child's Information:

Credit Card

Dismissal / Authorized Child Pick-Up Information:

Emergency Contact Information

ADDITIONAL INFORMATION (Important information we should know about your child):