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2019 DARE Camp Registration and Waiver
D.A.R.E. Summer Camp Rules

On Site Center Rules

1. A current D.A.R.E. application with a signed waiver form must be on file with the staff before any members can become involved in any center activities.

2. While in the D.A.R.E. Center, the members will be required to treat themselves, other members, and the staff with respect.

3. When engaging in center activities, the member will participate in a positive and sharing manner, shall not use profanity or behave in a disruptive manner.

4. When using the D.A.R.E. center facilities or D.A.R.E. recreational equipment, care will be taken so that nothing is damaged or destroyed. Any and all damage will be reported to a staff member immediately.

5. Any injury to a D.A.R.E. member will be reported immediately to the staff.

6. At all times D.A.R.E. members will follow the directions of all staff members.

7. No acts of violence will be tolerated at the center.

8. No members will bring any drugs, cigarettes, alcohol, gang related clothing or paraphernalia, or weapons to the D.A.R.E. Center.

9. If refreshments are brought into the center, the members who brought the refreshments will be responsible for cleaning up any mess.

10. No loitering will be allowed outside of the center by members or non-members.

11. Failure of a member to follow these rules may result in the members being removed from the program.

12. No name calling, bullying, hitting, kicking, punching, or horseplay will be allowed.

13. Campers will follow directions of the adult/youth staff at all times.

D.A.R.E. Camp Calendar of Events
Tuesday June 11, 2019
8:15am Staff Meeting

8:15am-8:30am Information to Kids

8:30am-9:00am Team Meeting and Wood Crafts

9:00am-11:00am Obstacal Course and Games

11:00am-11:30am Lunch (Subs)

11:30am-12:00pm Team Meeting, Work on Posters and Wood Crafts

12:00pm-2:00pm Bowling

2:15pm-2:50pm Competition Games

3:00pm Camp Closed
Wednesday June 12, 2019

8:15am Staff Meeting

8:30am-9:15am Team Meeting

9:15am-10:55am Make Ice Cream

11:00am-11:30am Lunch (Pizza)

11:30am-12:15pm Team Meeting, Work on Wood Crafts

12:30pm-2:30pm Swimming, BRING SWIMSUIT, TOWEL, BAG FOR WET STUFF!

2:45pm Poster Contest

3:00pm Camp Closed

Thursday June 13, 2019
8:15am Staff Meeting

8:30am-9:30am Team Competition

10:00am-1:30pm Camp Clay 11:00am Lunch (Hamburgers and Hotdogs)

1:45pm-2:15pm Graduation and Door Prizes (Parents Invited)

2:15pm-2:30pm Clean Up Area

2:30pm-3:00pm Water Fight, D.A.R.E. Officers vs Campers, BRING YOUR WATER GUNS!!!

3:00pm Camp Closed, Staff meeting
***Schedule is Subject to Change***
D.A.R.E. Summer Camp Program
Accident Waiver

Participants Name: __________________________________________________________________________

Date of Birth: ___________________________________ Phone: ___________________________________

Address: __________________________________________________________________________________

Family Doctor: __________________________________ Phone: ___________________________________

Family Dentist: __________________________________ Phone: ___________________________________

List of Medications Participant is taking: ________________________________________________________



List and all physical/medical conditions which may affect participation in any D.A.R.E. Summer Program physical activity.

Please Explain: _____________________________________________________________________________




I, ___________________________________, release the Van Wert City Police Department, Van Wert County Sheriff’s Office, and the Van Wert City Schools, from any and all liabilities or responsibilities pertaining to accidents, injuries, or complications resulting from activities, or while transporting participants to or from activities. I authorize the D.A.R.E. Summer Program leadership to transport the above named participant to the nearest hospital in case of injury or suspected injury while the participant is involved in the D.A.R.E. Summer Program Activity.

I authorize the hospital. attending physician to administer necessary emergency professional medical care to the above named participant upon his/her arrival at the hospital.

Parent Signature: ________________________________ Date: _____________________________________

Parent Signature: ________________________________ Date: _____________________________________

D.A.R.E. Summer Camp Program
Membership Application

T-Shirts Adult Sizes Only Please Circle Size


Name: ___________________________________ Age: _______________ Sex: ___________________

Birthday: _________________________________ School: _________________________________________

Parent or Guardian: _________________________________________________________________________

Phone#: _________________________________ Cell#: __________________________________________

Emergency Contact Person: ___________________________________________________________________

Address: _______________________________________________________ Phone#: ________________

Parent or Guardian Signature: _________________________________________________________________

I agree to follow all rules and regulations concerning conduct and dress for D.A.R.E. Summer camp Program. Should I violate the rules, I understand that, I may be subject to expulsion from the program.

Camper Signature: ___________________________________________ Date: _________________________

Witness Signature: ___________________________________________ Date: _________________________

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Van Wert County Sheriff's Office
113 N. Market Street
Van Wert, OH 45891

Phone Business 419 238-3866           Emergency 911

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