Night On The Town |

Champions Night On The Town offers young adults an engaging evening of activities – including dinner, interaction with peers, songs, a bible lesson, and lots of entertainment. The creative programming of the Champions Staff offers individuals an exciting Night On The Town, while allowing other family members the flexibility to arrange their own night out.

The Champions Night On The Town evening features a variety of activities and Theme Nights:

Western Night
Sports Night
Bowling Night
Movies
Bible lessons
Talent Show
and other special themes and activities

The Spring 2015 Night On The Town events in Kansas City are held from 6:00 to 9:00pm at Hillcrest Covenant Church, 8801 Nall Ave, Prairie Village, KS 66207. The cost is $20 – payable at the door. (see the church web site or a map; see the Champions calendar…)

To register for a Night On The Town event in the Kansas City area, fill out the registration form below. The registration form will ask you if you have previously registered for a Night of Champions or Night On The Town event. If you have, and if your personal information is already in our files, you can skip many questions on the long form.

Night On The Town Registration Form - 2015

Items with an asterisk " * " are REQUIRED. The fields on this form may require 15 minutes to complete. Please have your personal info and medical info ready to go. The cost of a Night OnThe Town event is $20 - to be paid at the door.

1 Camper Information

2 Health and Insurance Information

3 Routine Care Information

4 Policies and Releases

POLICIES; HEALTH RELEASE; MEDIA RELEASE

Please carefully read each statement below. You'll be asked to initial each section using your mouse or touch screen, and to sign and date the document before you Submit.
Medication

Prior to the event, you will receive a medication form. You will be able to provide specific details on how and when to administer medication. The policy regarding medication is as follows: • Keep all medication in its original pharmacy labeled bottle or its original over-the-counter packaging. The medical staff will not dispense any medications not in its original container. This policy includes vitamins and herbs. • Place medication bottle or original over-the-counter package in a labeled Ziploc bag. • Include the medication form in the Ziploc bag with the medication needed for the week. • Bring your medication with the form on the first day of camp.
Special Information or Medical Needs

To help give the best care for your child, please provide detailed written instructions for any special medical needs beyond the information you provided on the Online form. If there is special information or routines for your child that absolutely must be adhered to, please contact our office at 913-638-6823 to discuss prior to the Event. We will make every effort to accommodate each child, but we need appropriate time for setting up special requests.
Special Diets

If your child requires a special diet beyond the information you provided on the Online form, please detail this in a statement and attach it. You will be required to bring your own food for lunch and snacks daily.
Behavior Issues

Children with a diagnosed behavior related disorder will be treated with care and respect as with all campers. All behavior issues at camp are dealt with in the following manner: • At first offense, the camper will discuss his or her behavior with their group staff leader and with their camp buddy. The three will discuss alternative behaviors that are appropriate. • At second offense, the camper, group staff leader and camp buddy will discuss the offense with the Camp Director and appropriate consequences will be initiated, such as withholding a favorite activity for one activity period. • At third offense, the camper, group staff leader and camp buddy will report to the Camp Director for discussion and appropriate consequences will be initiated. (This is equivalent to being sent to the school principal.) Special Needs Health Center will send the child home if it is deemed that the child is being a danger to self or others. Discipline is done through discussion and redirecting. It is a last resort to send a child home. • In no situation are physical measures utilized for consequences. Absolutely no spanking, slapping or other physical contact is ever used by anyone at camp for discipline.
Behavior Disorders

The camper with a diagnosed behavior disorder will always be treated with measures that are safe and respectful for the camper’s best interest. However, if the child has an outburst that causes danger to self or others, more stringent methods of control will be initiated. In all situations involving a “meltdown,” the first steps taken are assisting the child to regain control through calm talking and giving the child space. If after several minutes these methods do not produce a safe demeanor in the child, the next step is assessing the situation and removing the child from the group. Parents are notified of unacceptable behavior.
Phone Usage

Campers are not allowed to use phones during camp hours. Most campers do well at camp, but calling home can initiate a wave of homesickness.
Medical Emergencies

If a medical emergency occurs, parents or guardians will be notified as soon as possible. If a situation requires that a camper be taken to a hospital emergency room, the hospital staff will often contact the parent for information. Every effort will be made to contact the parent or guardian prior to the emergency staff contacting you. It is your responsibility to provide the necessary contact information while your child is at camp.
Cancellations

If your child will not be able to attend the event in which they are enrolled, you must notify Special Needs Health Center immediately.
Policies - Initial*
I have carefully read and understand the above Special Needs Health Center Inc. policies. I agree with the policies and will inform my camper of the rules and policies of camp. (Initial with your mouse or touchscreen.)
Release of Liability - Initial*
I understand that Special Needs Health Center Inc. is NOT responsible for loss of clothing or personal property while at events. I agree to bring all articles of clothing and personal property clearly marked with my first and last name. I understand that part of the day camp experience involves activities, group social arrangements and interactions. These activities and interactions may come with certain risks or uncertainties, and I am aware of these risks. I realize that no environment is risk-free, and I understand risks are minimized when following the rules as instructed by the camp staff. These rules are made to insure safety for all and I agree to follow all rules. I hereby, and for my heirs, executors, and administrators, assigns and all legal guardians, waive and release any and all rights and claims of any nature I may have against Special Needs Health Center Inc., its directors, collectively and individually, employees, Board of Directors, coaches, campers and cooperating entities for and against any and all injuries and damages of any nature, including death, which I may suffer while taking part in Special Needs Health Center Inc. Day Camp or other activities associated with Special Needs Health Center Inc. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE Special Needs Health Center, INC., RELEASE OF LIABILITIES. (Initial using your mouse or touchscreen.)
Medical Authorization and Privacy Agreement - Initial*
I hereby give permission to the physician selected by the Camp Director to order routine medical tests, X-rays, and treatment for emergency health concerns in the event that the parent/guardian cannot be reached. I give the members of the camp medical team permission to administer over-the-counter medications as needed and to give scheduled medication as ordered on the Medication Instruction Form. I realize the camp has a limited liability medical policy for volunteers with a $2,500 maximum limit, covering only trauma, not illness. Any medical expenses in excess of this amount will be my responsibility. I authorize any physician, nurse or other health care provider to communicate with the camp medical staff and any Director of Special Needs Health Center, or his/her designee, concerning my medical condition, treatment and/or prognosis. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE Special Needs Health Center, INC., MEDICAL AUTHORIZATION AND PRIVACY AGREEMENT. (Initial using your mouse or touchscreen.)
Media Release - Initial*
I realize that photographs and films of camp activities may be taken and used for fund-raising and publicity purposes. I hereby give my consent to Special Needs Health Center Inc., its officers, employees, agents, chapters, assignees, licensees and cooperating entities, to use my picture, name, portrait, likeness, writings or biographical information, and/or audio tape for editorial, educational, promotional and advertising purposes, for the solicitation of contributions and for any other purposes in furtherance of the corporate purposes and objectives of Special Needs Health Center, Inc. This release and consent shall be binding upon my child’s heirs, executors, administrator, assigns, and all legal guardians of my child. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE Special Needs Health Center, INC., MEDIA RELEASE. (Initial using your mouse or touchscreen.)
Full Signature*
I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH ALL POLICIES AND STATEMENTS IN THIS Special Needs Health Center, INC., NIGHT OF CHAMPIONS REGISTRATION FORM. (Add your signature below with your mouse or touchscreen.)
Today's Date*
(Legal signature requires you to pick the date you signed...)

Night On The Town

Night On The Town Registration Form - 2015

NIGHT ON THE TOWN ATTENDEE'S INFORMATION:

HEALTH AND INSURANCE INFORMATION:

ROUTINE CARE INFORMATION

POLICIES; HEALTH RELEASE; MEDIA RELEASE

Medication

Special Information or Medical Needs

Special Diets

Behavior Issues

Behavior Disorders

Phone Usage

Medical Emergencies

Cancellations