Gender(Required)

T-Shirt Size(Required)

Camper Lives With:(Required)

Transportation information – Families have busy lives and often make various transportation arrangements for their children, both dropping off and picking up from camp. To ensure that the children are only released to the proper adults, Pre-Vet and Vet Science Camp requires all children to be signed out and the individual picking them up must be on the approved pick up list provided by the parent AND show photo ID at the time of pick up. If camp attendees are permitted to drive, they will be allowed to sign themselves out; however, they are not permitted to drive to the field trip locations. To ensure your child's safety, please list below the individuals authorized to sign out your camper.

Refund & Cancellation – For cancellations prior to May 1, a 100% refund is provided. For cancellations between May 1 and June 1, a 50% refund is provided. For cancellations after June 1, the total fee is forfeited. In the event that your child enrolls in camp and withdraws because of homesickness or is asked to leave because of misconduct, there will be no refund. We, the parent/guardian of the camper, have read and understand the terms and conditions of the Refund and Cancellation Policy and agree to subscribe to them by checking the box below.

I agree(Required)

Camper Dismissal – A camper whose behavior is disruptive to the camp program or harmful to himself/herself, others, or the property of the camp or others will be dismissed at the discretion of the Camp Director, with no refund of fee. Upon dismissal, the parent/guardian must arrange for immediate pick up of the child, regardless of the location of the camp at the time of the incident. We, the parent/guardian of the camper, have read ad understand the terms and conditions of the Camper Dismissal policy and agree to subscribe to them by checking the box below.

I agree(Required)

Parent/Guardian Agreement and Waiver – We, the undersigned parents/guardians of the camper named on this application, acknowledge that we are fully aware that certain elements of danger are inherent in the activities sponsored by the Roanoke Valley SPCA, which are beyond the control of the agents, the land owners, employees and volunteers of Roanoke Valley SPCA and that participation in any program activities may entail unavoidable risk of personal injury, death and loss or damage to property. We are aware of the types of activities in which the child will be participating during his/her stay and have been given ample opportunity to ask any questions which we may have about the camp the child will be participating in or the activities involved. We are aware of the dangers that are inherent in the operation of any child's camp and in the child's participation in all camp activities on or off premises of said camp. We grant permission to use any photograph or video for personal use, knowing it will be done in good taste. We, the parent/guardian of the camper, have read and understand the terms and conditions of the Parent/Guardian Agreement and Waiver, and agree to subscribe to them by checking the box below.

I agree(Required)

Health Authorization

Is this child taking medication on a routine basis?(Required)
Which of the following has the camper had?(Required)
Is the camper current on all immunizations?(Required)

COVID-19

Common surfaces at the Roanoke Valley SPCA are sanitized frequently and public/volunteer access to building is by appointment only. Masks are required for all non-vaccinated individuals and social distancing practiced. All Roanoke Valley SPCA summer camp staff have been required to be vaccinated against COVID-19.

During the week of camp, as campers travel to program partners in the van, they will be in close contact with each other and social distancing is not possible. In an attempt to be as safe as possible, we are requiring that all campers comply with the following COVID health and safety guidelines in order to participate in summer camp:

  1. All campers must be up-to-date with COVID-19 vaccines as outlined in the CDC guidelines listed below, including a booster shot if appropriate. The recommendations are different depending on your age, your health status, and when you first got vaccinated. Upload/email a copy of the vaccine card a minimum of two weeks to start of camp.
  2. All campers must bring a mask to camp each day and comply with program partner guidelines to wear the mask if requested.
  3. Participants may not attend camp if they are experiencing any signs or symptoms of illness.
  4. Participants are required to alert the program coordinator if they have been exposed to a positive COVID-19 individual. According to the CDC guidelines, an exposure is considered when an individual has been within six feet of a positive individual for at least 15 minutes. Neither individual's vaccine status matters when determining an exposure. If a participant is exposed, they will be required to follow the CDC guidelines. CDC guidelines at this time are for exposed individuals to wear a mask for a minimum of 10 days following exposure. Quarantine/isolation is not required and participants may continue to attend camp as long as they are asymptomatic and wear a mask at all times (except lunch).
  5. The Roanoke Valley SPCA may update our COVID-19 protocols at any time, including during camp. If protocols change, guardians will be notified of all changes and participants will be expected to comply with any updates.
  6. The Roanoke Valley SPCA will not refund any full or partial fee for participants who withdraw from camp because of a COVID-19 exposure, positive diagnosis, illness, or any other reason.

Has your child has any recent injury, illness, or infectious disease?(Required)
Does your child have a chronic or recurring illness or condition?(Required)
Has your child ever been hospitalized?(Required)
Has your child ever had surgery?(Required)
Has your child ever had a head injury?(Required)
Has your child ever been knocked unconscious?(Required)
Has your child wear glasses, contacts or protective eyewear?(Required)
Does your child have frequent ear infections?(Required)
Has your child ever passed out during or after exercise?(Required)
Has your child ever been dizzy during or after exercise?(Required)
Has your child ever had a seizure(s)?(Required)
Has your child ever had chest pain during or after exercise?(Required)
Has your child ever had high blood pressure?(Required)
Is your child able to swim?(Required)
Has your child ever had back problems?(Required)
Has your child ever had joint problems?(Required)
Does your child have an orthodontic appliance being brought to camp?(Required)
Does your child have any skin problems?(Required)
Does your child have diabetes?(Required)
Does your child have asthma?(Required)
Has your child had mononucleosis within the past year?(Required)
Does your child have problems with diarrhea or constipation?(Required)
Does your child have an eating disorder?(Required)
Does your child have a learning disability?(Required)
If female, does your child have abnormal menstruation?(Required)
Are there any conditions that we should be aware of that may affect the camper's ability to participate in out programs?(Required)

The above health history is correct and complete as far as I know and the person herein described has permission to engage in all camp activities except as noted. I hereby give permission to the camp to provide routine health care, administer prescribed medications and seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to the camp to arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization for the child named above, All prescription medication must be turned over to camp staff for handling and administration, in its original container with clear instructions. All Over-the-Counter medication must be turned over to camp staff with written instructions from parent(s)/guardian(s) regarding administration.

We, the parent(s)/guardian(s) of the camper, have read and understand the terms and conditions of the Parent/Guardian Agreement and Waiver, and agree to subscribe to them by signing below.

I agree(Required)