C.H.A.S.E. (Camp Hurricane Activities and Summer Education)

C.H.A.S.E. Image result for SUMMER CLIP ARTImage result for SUMMER CLIP ART

(Camp Hurricane Activities and Summer Education)

Hayward Intermediate School ~ 15930 W. 5th Street ~ 715-638-9301

2018 Registration Forms at

Child’s Name: ____________________________________________     Gender: M F

Birth Date: _________________________________________________________________                                               

Home Address: _____________________________________________________________

City: ___________________________  Zip Code: _________________________________

Please circle which grade your child will be entering for the ’18-’19 School Year:

4th Grade                    5th Grade                    6th Grade

Parent/ Guardian 1-Name: __________________________________________________________

Address: ________________________________________________________________________

Please list all phone numbers:

          Home: ___________________ Cell: ___________________ Work: ________________

          Email: _________________________________________________________________

Parent/ Guardian 2-Name: ________________________________________________________

Address: ______________________________________________________________________

Please list all phone numbers:

Home: ___________________ Cell: ___________________ Work: ____________________

Email: _____________________________________________________________________

List all persons authorized to pick up your child from C.H.A.S.E.:

Including parent names:

          Name: ___________________________ Phone: _____________________________

          Name: ___________________________ Phone: _____________________________

          Name: ___________________________ Phone: _____________________________

          Name: ___________________________ Phone: _____________________________


Local Emergency Contact Person (other than parent):

Name: __________________Phone: ________________ Relationship:_______________

Does your child have medical needs:  Yes No


If yes, please explain your child’s needs. Please include all allergies and any other special emergency care

instructions or medical information needed by the child care staff.



By registering or participating, the registrant recognizes that all recreational activities have a certain degree of risk and understands that individual accident insurance is not available.  I agree to assume all medical costs incurred should injury result from participation in these activities. I hereby agree to hold the Hayward Community Schools, its employees and agents and any and all persons or entities holding thereunder, including any and all policies of insurance, harmless from any and all claims, suits, obligations or other liabilities which arise or may arise out of my child’s participation in such activities and use of the recreational facilities and equipment.

During CHASE pictures or videos are taken of students doing a variety of our activities. These pictures may be used in any number of different ways including; district web pages,and items for local newspaper. When a picture or video is displayed the student(s) will not be identified by name(s). Please complete the consent which indicates your wishes for the use of pictures or videos that include your son/daughter.

_____ I consent to the use of my son’s/ daughter’s picture

_____ I DO NOT consent to the use of my son’s/ daughter’s picture

Start Date: June 11-28, 2018


Hayward Intermediate School

Hours: 7:30am- 11:30am

~The registration fee for C.H.A.S.E. is $25.00 for all 3 weeks. Payment needs to be paid by June 1, 2018.

Please make checks payable to Hayward Community School District.

~The first 100 children that have the registration form and fee paid by June 1, 2018 will be accepted.

First Week:

Northwoods Week

Second Week:

Sports Week

Third Week:

Under the Sea Week

** Fun summer treats will be served.

** Tentative Calendar to follow.

If you have questions or concerns please email Lacie O’Brien at lobrien@hayward.k12.wi.us or call 715-638-9502, Kim Lambert at klambert@hayward.k12.wi.us or call 715-638-9508.

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