Harper Woods Leadership Camp

Name: Harper Woods Leadership Camp
Start: 2023-06-19T08:30:00-04:00
End: 2023-06-23T15:00:00-04:00
Location: Peace and Goodwill Baptist Church

Details

Start:

June 19 @ 8:30 am

End:

June 23 @ 3:00 pm

Venue

Peace and Goodwill Baptist Church; 20955 Bournemouth St
Harper Woods, MI 48225 United States + Google Map
Website:: www.careofsem.com

Each year CARE of Southeastern Michigan works with students and families to educate and implement substance use prevention in the lives of the individuals we serve. CARE holds weekly educational workshops and hosts various summer camps for school-aged kids.

Leadership Camp activities help increase resiliency, self-esteem, and team building to empower students to be leaders in their communities. Students can expect a week of fun, “out of the box” experiences!

CARE will be hosting the camps in Harper Woods, Fraser and Eastpointe
Camp is from 8:30 AM to 3 PM
Boxed lunches will be provided
Students will have access to the indoors with assigned classrooms for each grade level participating

For any questions, contact Kristen Johnson at kjohnson@careofsem.com or 586-541-2273

June 19 – June 23

6th – 8th Grade
8:30 AM – 3:00 PM | Peace Goodwill Church, 20955 Bournemouth, Harper Woods, MI 48225
Empowering Youth • Strengthening Life Skills • Character Development • Games, Arts, & Crafts
Cost: $0

Leadership Camp 2023

Leadership Camp Registration 2023
Parent/Guardian Information
Parent/Guardian Name*
Parent/Guardian Phone Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Email Address*
May we send mail to your address?*
- Yes
- No
May we call you?*
- Yes
- No
May we leave messages on your phone?*
- Yes
- No
May we send email to your email address?*
- Yes
- No
How did you hear about our leadership academy?
Has you child/children participated in CARE's Leadership Academy before?*
- Yes
- No
Child's Name*
Child's Date of Birth*
MM slash DD slash YYYY
School Name and District*
Grade in 2023-2024 School Year*
Which camp are you registering for?*
You can choose more than one. Please note: all leadership camps offer the same curriculum and activities. If you have any questions, please contact the camp coordinator.
- Harper Woods (June 19-23)
- Eastpointe (June 26-30)
- Fraser (August 7-August 11)
Does your child have difficulty making/keeping friends?*
- Yes
- No
Does your child have difficulty managing anger?*
- Yes
- No
Does your child have trouble staying focused?*
- Yes
- No
Are there any learning disabilities, physical disabilities, health concerns, or mental health concerns?*
- Yes
- No
Please list
Is your child attending counseling/ support groups*
- Yes
- No
List all medications your child is taking?*
Put N/A if does not apply
List all allergies (food, medication and animals):*
Put N/A if does not apply
Tell us a few of your child's strengths and postive qualities?*
Child 2 (if registering multiple children)
Child's Name
Child's Date of Birth
MM slash DD slash YYYY
School Name and District
Grade in 2023-2024 School Year
Does your child have difficulty making/keeping friends?
- Yes
- No
Does your child have difficulty managing anger?
- Yes
- No
Does your child have trouble staying focused?
- Yes
- No
Are there any learning disabilities, physical disabilities, health concerns, or mental health concerns?
- Yes
- No
Please list
Is your child attending counseling/ support groups
- Yes
- No
List all medications your child is taking?
Put N/A if does not apply
List all allergies (food, medication and animals):
Put N/A if does not apply
Tell us a few of your child's strengths and postive qualities?
Child 3 (if registering multiple children)
Child's Name
Child's Date of Birth
MM slash DD slash YYYY
School Name and District
Grade in 2023-2024 School Year
Does your child have difficulty making/keeping friends?
- Yes
- No
Does your child have difficulty managing anger?
- Yes
- No
Does your child have trouble staying focused?
- Yes
- No
Are there any learning disabilities, physical disabilities, health concerns, or mental health concerns?
- Yes
- No
Please list
Is your child attending counseling/ support groups
- Yes
- No
List all medications your child is taking?
Put N/A if does not apply
List all allergies (food, medication and animals):
Put N/A if does not apply
Tell us a few of your child's strengths and postive qualities?
Transportation
I give my child permission to:*
- Walk home
- Be picked up by myself (parent/guardian)
- Be picked up by other adult
If picked up by other adult, please include their information below.
Information of other adult given permission to pick up your child/children (other than yourself)
Name
Relationship to Child
Phone
Email Address
Emergency Contacts (Please Provide 2)
Emergency Contact 1 - Name*
Emergency Contact 1 - Relationship to Child*
Emergency Contact 1 - Phone Number*
Emergency Contact 2 - Name*
Emergency Contact 2 - Relationship to Child*
Emergency Contact 2 - Phone Number*
Social Media and Photo Consent
Social Media Release*
Parent/Guardian by typing your name below you grant CARE of Southeastern Michigan the absolute and irrevocable right and unrestricted permission concerning the use of photographs that may be taken which may include with others, to use, reuse, publish, the photographs in whole or in part, individually or in connection with other materials. I release and discharge photographer from any and all claims that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for liable or violation of any right of publicity or privacy.
- Yes
- No
Participating Consent
Parent/Guardian by typing your name below you give permission for my child to participate in the Care of Southeastern Michigan Leadership Academy. I give permission for my child/children to participate in the Care of Southeastern Michigan Leadership Academy. I understand the significance and importance of this program and I will take an active role in this experience and will support my child's understanding of the concepts and ideas it presents. I understand that my child will be required to complete a pre/post evaluation for the camp and that the purpose of this evaluation is to help CARE staff demonstrate that the program is effective and impactful for the participating youth. I also understand that CARE of Southeastern Michigan staff are mandated reporters and should there be concerns of neglect, abuse, or harm to others, CARE staff will be required to report these concerns. CARE of Southeastern Michigan reserves the right to remove youth should they not be an appropriate fit for camp. If CARE staff suspects that the person designated to pick up my child is under the influence of intoxicated, an alternative ride home must be identified.
Parent/Caregiver Signature*

Please type full name as this electronic signature will serve as your consent.
Today's Date*
MM slash DD slash YYYY

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Venue

Peace and Goodwill Baptist Church; 20955 Bournemouth St
Harper Woods, MI 48225 United States + Google Map
Website:: www.careofsem.com

Harper Woods Leadership Camp

Details

Venue

June 19 – June 23

Leadership Camp 2023

Leadership Camp Registration 2023

Parent/Guardian Information

Child 2 (if registering multiple children)

Child 3 (if registering multiple children)

Transportation

Information of other adult given permission to pick up your child/children (other than yourself)

Emergency Contacts (Please Provide 2)

Social Media and Photo Consent

Participating Consent

Venue