English Version

Summer Reading Camp Application

For students entering Kindergarten through Grade 3

Camp Dates
06/29/26 to 08/21/26

Time
9:00 AM to 2:00 PM

Location
50 N. Clinton Ave., Trenton, NJ 08609

Submit To
rodfamfoundation@gmail.com

This summer reading camp is designed to strengthen early reading skills through research-based instruction in phonemic awareness, phonics, fluency, vocabulary, comprehension, read-alouds, small-group practice, and family reading support. Daily on-time arrival is required.

Student Information

Student Full Name * Date of Birth * Grade Entering in Fall * Current/Previous School Home Address City/State/ZIP Primary Language Student T-Shirt Size Does the student have an IEP, 504 plan, or reading support plan? Preferred reading level or current concern Books/interests the student enjoys

Parent/Guardian Information

Parent/Guardian 1 Name * Relationship Phone * Email * Parent/Guardian 2 Name Relationship Phone Email

Emergency Contacts and Authorized Pickup

Only the people listed below may pick up the student. A photo ID may be required.

Name Relationship Phone Authorized?

Health, Allergy, and Medication Information

All allergy information must be completed before the child attends camp. If the child has a food allergy, environmental allergy, asthma, seizure condition, or other medical concern, attach a current care plan or emergency action plan when available.

No known allergies Food allergy Medication allergy Environmental allergy Asthma, seizure, diabetes, or other health concern Student carries/uses EpiPen, inhaler, or other emergency medication Medication needed during camp hours Special dietary restrictions or snack instructions

Physician/Clinic Physician/Clinic Phone

Attendance and Punctuality Agreement

Students must arrive on time each day. Parents/guardians must notify camp staff if the student will be absent or late. Students must be picked up on time at dismissal. Students should attend the full camp session unless sick or excused.

Parent Permissions

I give permission for my child to participate in reading camp activities. I give permission for staff to provide basic first aid and contact emergency services if needed. I understand that I must provide accurate allergy and health information before my child attends. I give permission for my child to receive snacks provided by camp, except as restricted above. Photo/video permission for camp promotion

Parent/Guardian Signature

By submitting, I confirm that the information provided is true and complete. I understand the attendance, punctuality, allergy, safety, and pickup expectations.

Parent/Guardian Signature * Date * Printed Name *

Submissions are sent to rodfamfoundation@gmail.com.