• THE SUMMER THAT CRANKED

    A Summer Program for the Youth based on DMV Culture and GoGo

  • Camp Dates: June 22- August 15, 2026

    Camp Hours: Monday to Friday, 8:10 AM - 4:00 PM

    Before Care: 6:30 AM-8:00 AM *ADDT'L FEE

    After Care: 4:00 PM -6:00 PM *ADDT'L FEE

    Ages: 6 to 17

    Location: Temple Hills, MD

  • Participation Agreement: I understand and agree to follow all camp rules and policies. I will provide breakfast and lunch daily and ensure timely drop-off and pickup.

  • Confidentiality Notice: All information collected on this form is confidential and protected under HIPAA and Maryland state confidentiality laws. Information will only be used to provide services and support the safety and well-being of your child.

  • SECTION 1: CAMPER INFORMATION

  • Date of Birth
     - -

  • SECTION 2: PARENT/GUARDIAN INFORMATION

  • Format: (000) 000-0000.

  • SECTION 3: EMERGENCY CONTACT AND HEALTH DISCLOSURE

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • I authorize MAPAC and Skinner Enterprises to seek emergency medical care and, if needed, exchange relevant medical information with emergency personnel or medical providers for treatment purposes.

  • SECTION 4: HEALTH, INSURANCE & SAFETY INFORMATION

  • Note: If your child is enrolled in Medicaid, Skinner Enterprises, may be able to bill for applicable behavioral health support services delivered during camp hours. Parents will be contacted before any billing occurs.

  • Does your child have any medical conditions?
  • Does your child have any allergies?
  • Does your child take any medications?
  • Can your child participate in full physical activity?
  • Does your child currently receive behavioral health services (e.g., therapy, counseling, medication management)?

  • SECTION 5: PROGRAM DETAILS

  • Type a question
  • Is your child enrolled in MARYLAND Medicaid?
  • Would you be interested in before/after care services if they became available? *Additional Fees*

  • SECTION 6: RELEASES AND SIGNATURES

  • PHOTO & VIDEO RELEASE: I give permission for MAPAC and Skinner Enterprises to photograph or video my child during camp activities.
  • Emergency Medical Release: I authorize MAPAC and Skinner Enterprises to seek emergency medical care for my child if I cannot be reached.
  • Behavioral Health Services Consent: I authorize Skinner Enterprises to provide behavioral health support or emotional regulation interventions for my child as needed during camp programming.
  • As part of our camp program, each child is required to have an adult participate in behavioral health services alongside them. This support helps campers get the most out of their experience, reduces missed days, and strengthens family relationships.

  • Our behavioral health team, Skinner Enterprises, provides group sessions aligned with camp activities, as well as one-on-one support for both children and their participating adults. They are available on-site and, in the field, to respond to needs in real time, assist with community resources, and offer additional support through home visits and outings.

  • We are proud to have a dedicated team of providers you will come to know and trust. For families who continue services during the school year, support can extend to afterschool activities and events.
  • Please feel free to speak with any of our camp counselors about their experiences with these services, or connect with our behavioral health staff, who are always available to answer questions.

  • I understand that MAPAC and Skinner Enterprises are not responsible for personal items lost or damaged during camp. I also acknowledge that behavioral incidents may require temporary removal from programming for safety reasons.

    I understand that MAPAC and Skinner Enterprises are not responsible for personal items lost or damaged during camp. I also acknowledge that behavioral incidents may require temporary removal from programming for safety reasons.

  • Participation Agreement: I understand and agree to follow all camp rules and policies. I will provide breakfast and lunch daily and ensure timely drop-off and pickup.

  • Date Received MM/DD/YYYY
     - -
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