Your daughter "Charis" Sanchez (F) 2024

Gender Identity Female Age 11.05

Pronoun She/Her DOB 10/25/2012

Grade 6th Date applied 3/30/2024

School Midorino School Tokyo, Komae. T-Shirt Size Youth S

PERMANENT ADDRESS
Address ?????????1??25?56?202?
Address 2 Tokyo,KomaeShi,Nishinogawa 1-
25 building 56-Apartment 202.
City Komae, Nishinogawa
State Tokyo
Zip 201-0001
Country JP
PARENT1 PARENT2 EMERGENCY CONTACTS
First Name Mr. John First Name Mr. Gabriela Name & Relationship Jhon Sanchez
Last Name Sanchez, Sr Last Name Triviño, Sr Telephone Number +810872057044
Relationship Parent Relationship Mother Name & Relationship Gabriela - Mom
Login Email jhonefrainsanchez@gmail.com Cell Phone +573187902204 Telephone Number +573187902204
Cell Phone +8108072057044

SESSION ASSIGNMENTS
Hidden Valley Summer Camp
Second Session / HV Camper [EN]
Jul 21, 2024 - Aug 15, 2024
Days of Week: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Description: July 21- Aug 15Get ready for the summer of a lifetime at HVC... Friendship, new skills, amazing special events and and an
independent life with other enthusiastic campers and talented, caring, upbeat staff.

Enter up to 2 friends my camper would like to bunk with.

CUSTOM FIELDS
Information about your camper's personality, interests at home and camp, personal development, etc. She's outgoing, creative and friendly.
She's been trying Ballet, Violin,Tennis and Basketball during the last two years from time to time. She's a fervent Catholic who goes to mass
on every Sunday and is an altar girl from time to time. We have always lived in Colombia as a family of four, mom, dad, sister and her 4 year
old sister, Guadalupe. She's been in the USA on family vacations before. This will be her very first time sleeping out of home.
Had seizures when she was 4 due to body high temperature. Got an
Please discuss any health or diet issues about which we should know.
appendix surgery when she was 5. Is attending online psychology sessions due to low self steem and suicidal ideation.
She's going to a Japanese School since
Please share with us any info about the previous year at home, at camp, in school, or with peers
December 2023z She's facing a big challenge by learning the language and adapting to the Japanese culture in a public Tokyo School with
no friends, a lot of social pressure along family demands of catching up with language and school tasks. This has overburdened her and
as a consequence her passion towards violin and things that demand discipline has become weaker. Her personality is always changing
and feeling she's not the same as before. She has become extremely nervous to failure and has had low self steem issues. She's
currently attending online psychology sessions twice a week.
All-Gender Cabin I do not have any questions.

TERMS & CONDITIONS

Please sign below in agreement with policies supporting camp operations and participant health, safety and comfort.

1. Tuition: Camp deposit due with registration. Tuition balances for all fees, as set forth on the HVC website and Camper Application, must
be paid in equal installments on January 20 and March 20. If applicable, I give Hidden Valley Camp permission to debit my account for the
tuition amount owed on the dates to which I have agreed.
2. Refunds:

• No fee reduction or refund is made for non-arrival, late arrival, or early withdrawal.
• A 50% refund of the tuition deposit can be made within 30 days of registration. There are no deposit refunds provided after May
1st.
• In cases of camper illness/injury only, a prorated refund - less deposit - is granted at Directors’ discretion.
• There is no refund of any fees in the event of epidemic, pandemic, disease or fear thereof (including, but not limited to, Covid-19),
vandalism, fire, explosion, storm or other natural disaster, or national emergency or other acts of governmental authority.

3. Medical Policies: All medical forms must be completed in their entirety by a physician during the summer’s calendar year and based on physical exam at
most 12 months prior to camp, signed by parent, and received in the camp office by May 1st.

• Camp may not accept a camper whose form has not arrived or is inconclusive with regard to information relevant to a child’s health
or that of the camp population (infectious diseases, required immunizations, etc.)
• Parents/guardians agree to provide camp advance notification of a camper’s medical condition, illness, or injury and written
clearance from physician to participate in camp. Parents/guardians further understand and agree that camp medical personnel will
review such documentation and that camp may not be able to accept and accommodate a child if that child’s participation in camp
puts the child or others at risk.
• Parents/guardians agree to provide camp with their family’s insurance information to cover all medical costs outside of camp’s
Health Lodge.
• Parents/guardians agree to adhere to all medication and medical policies as noted on the camp Web site, including all policies and
precautions relating to Covid-19.
• Parents/guardians agree to provide camp with their family’s insurance information to cover all medical costs outside of camp’s
Health Lodge.
• Parents/guardians agree to adhere to all medication and medical policies as noted on the camp Web site, including all policies and
precautions relating to Covid-19.
• Proof of covid vaccine is required for all participants for whom it is available.

4. Medical Treatment: I hereby authorize any medical personnel selected by the camp director or nurses to order x-rays, routine tests, and other medical
treatment that support the health of my child. In the event that I cannot be reached in an emergency, I give permission to the medical personnel selected by
the camp director or nurses to hospitalize, secure proper treatment, and to order injections, anesthesia, surgery and any other procedure for my child.

5. Conduct: Families are ultimately responsible for participants’ behavior. We have set a limit on the attention that camp directors and staff will extend to
campers who behave disruptively or disregard policies concerning safety and consideration toward other campers or staff. The camp reserves the right to
dismiss campers as a result of disruptive, unsafe and/or abusive behavior. There is no refund in such an instance. Parents/guardians agree to take immediate
responsibility for children, including transportation home, should dismissal occur.

• If, in the Directors’ judgment, campers’ family members act in such a way as to disrupt camp operations, or if they do not cooperate
in jointly working with Directors to support a child’s camp adjustment, enrollment may be canceled before or during the camp
session. No refunds are provided in such instances.

6. Images: Permission is granted to camp to use photos/videos of campers for promotion to current and future families.

7. Release and Indemnity: Permission is granted to Hidden Valley Camp for my child’s participation in all programs and activities and for
participation in out-of-camp activities and trips, including transportation off-camp premises, during camper’s enrollment at camp. I have
reviewed the Camp materials and am aware of all activities being offered to my child while at Camp and I understand that these programs
involve inherent risk which may result in bodily injury and other damages. I agree to waive and release any and all claims I may have
against Hidden Valley Camps, Inc. and its employees, directors, officers, volunteers, and agents for any and all claims I may have against
them, including claims arising out of or resulting from negligence on the part of Hidden Valley Camp.
Further, in consideration of my child’s being permitted to participate in camp and to use Camp’s facilities and equipment, I further agree to
indemnify and hold harmless Hidden Valley Camp and its employees, directors, officers, volunteers, and agents with regard to any and all
present and future claims that may be brought against them, including any claims brought by my child, for injuries or damages that may be
incurred by the camper as a result of participation in said activities, including any claims arising out of or resulting from Hidden Valley
Camp’s negligence or fault.

8. Jurisdiction: All disputes related to these policies or any other aspect of camper’s or family’s relationship with camp will be addressed
and settled in Waldo County, Maine. Anyone bringing legal action against Hidden Valley Camps, Inc and/or its directors and officers which
results in a decision in favor of Hidden Valley Camps, Inc. will be responsible for all related legal, court, and out of pocket expenses of
Hidden Valley Camps, Inc., its directors, officers and employees.

9. Other Policies: Parent/guardians and campers agree to abide by all policies noted here and on the HVC Web site including but not
limited to those related to medication, what to pack, banned substances, communication with camp, travel and visitation.

b I understand and agree to the above. (Please note: Camp cannot accept altered copies of this page unless initialed
c
d
e
f
g
by both parent/guardian and camp director.)
Signature Jhon Sanchez (210.194.190.169) Date 3/31/2024

FAMILY FINANCIALS
CHARGES $7,450.00
Your daughter "Charis" Sanchez
 HV Camp - 2nd Session $7,450.00

NEW FAMILY BALANCE $7,450.00

DUE NOW FOR YOUR DAUGHTER "CHARIS" SANCHEZ $1,950.00

DEPOSIT
The deposit will be paid by check.

BALANCE
The remaining balance will be paid according to the terms of the Special Arrangements payment schedule.
Call our office.

BILLING ADDRESS
Address ?????????1??25?56?202?
Address 2 Tokyo,KomaeShi,Nishinogawa 1-25 building 56-Apartment 202.
City Komae, Nishinogawa
State Tokyo
Zip 201-0001
Country JP