Winter Camp

Holly Jolly Camp 

Don’t want the kids bored at home all break? Prance over to the fun with the Recreation Department! Please pack a lunch, a drink, and wear comfy clothes and gym shoes for the action-packed excitement. We will do sports, games, arts & crafts, and so much more! . 

Ages: 3–12 years 

Location: Village Commons Gym/Preschool 

Code# 

Day 

Time 

Date 

Fee 

2701-1

Tu–F 

9-4 pm 

12/26–12/29 

$140R/$150NR 

3701-1 

Tu–F 

9-4 pm 

1/2–1/5 

$140R/$150NR 

Before filling out Winter Camp Emergency Form sign up for Holly Jolly Camp and make a payment.

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North Riverside Winter Camp Emergency Form

  1. NORTH RIVERSIDE WINTER CAMP EMERGENCY FORM 2023
  2. Holly Jolly Camp
  3. Camper 1
  4. Camper 2
  5. Camper 3
  6. Parent / Guardian #1
  7. Emergency Contact Information

    Please list emergency contacts (other than the Parents/Guardian). Parents/Guardian will be contacted first.  

  8. Can pickup child*
  9. Can pickup child
  10. ALL CAMPS

    Please list individuals authorized to pick your child up after camp in addition to parents/Guardian and emergency contacts (A Photo ID is requested from the individual at pick up.)  

  11. Emergency Transportation Notice

    Please note that in the event you or the designated emergency contact cannot be reached within 15 minutes of injury, the paramedics will take the camper to the local hospital. If on a field trip, camper will be transported to the closet area hospital, by paramedics.

  12. Consent and Authorization

    I understand that the North Riverside Recreation Department and all employees working for the Department and the Village

    are not liable for any accidents or injuries incurred. By partaking of classes, in or out of town, or on trips, I assume all

    responsibility in case of injury and financial liability for medical expenses. By partaking in any recreation program, I

    release, waive, absolve, and indemnify the above from any financial responsibilities. It is recommended that the participant

    review his/her own personal insurance policy for adequate coverage during all program activities. I hereby consent to the

    use of my photograph in the North Riverside Recreation brochures, publications, slide presentations, etc.

    I further agree to abide by all policies and procedures set forth by the Recreation Department in the Day Camp Parent

    Manual as well as the Day Camp Behavioral Guidelines. I have read and understand the parent manual and agree to follow

    all policies and procedures set forth in the manual.

    Medical Release: In the event that no one can be reached, I hereby give my permission for my child to receive necessary

    emergency transportation and/or treatment. I agree to the emergency transportation notice on the reverse side of this form.

    Refund and Cancellation/Transfer Policy: Refunds for Camp will be issued only if a replacement person is found and

    enrolled. Spaces cannot be held. A $10 fee will be assessed for transfers.

    I, as the signee/authorized guardian, agree to all aforementioned information.

  13. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  14. Leave This Blank:

  15. This field is not part of the form submission.