Playground & Xtreme Teen Summer Sites Forms

Required Forms Process


It is the parent/guardian responsibility to deliver all necessary, completed forms to each program location. Children may not attend any session without completed forms on-site - no exceptions. Once you've selected the program you want for your child, a pop-up screen will appear listing 8 prompts which you are required to answer to complete a registration. The prompts are:
  • Emergency Contact Name (other than parent/guardian)
    • Please provide the full name of the person to contact in case of an emergency.
  • Emergency Contact Phone Number (other than parent/guardian)
    • Please provide the phone number of the emergency contact.
  • Physician's Name
    • Please provide the name of your child's physician.
  • Physician's Phone Number
    • Please provide the physician's phone number.
  • Is the participant a swimmer/non-swimmer?
    • Please indicate whether the child is a swimmer or a non-swimmer. (See page 4 of the camp brochure or online flip book.)
  • Are there any health issues?
    • Please answer Yes or No. Participants who have health issues such as allergies or other illness, take medication (prescription or over-the-counter), or use emergency medical devices such as inhalers or Epi-pens should answer Yes.
    • The Health-Medication Form will be printed with your Day Camp Confirmation Receipt at the end of the registration. This form must be completed and returned to staff prior to your child's participation in the day camp program. If you answer No, additional health forms are not required.
  • Has the participant been immunized?
    • Yes - student in a Maryland public or private school
      • If you answer Yes - and the student was in a Maryland public or private school, you will not need to complete a Maryland DHM Immunization Certificate.
    • Yes - student is home-schooled or was in a school other than in the state of Maryland school
    • No
      • If you answer No, or Yes, the student is home-schooled or was in a school other than the state of Maryland, then the Maryland DHM Immunization Certificate (PDF) will print out with your Day Camp Confirmation receipt. This certificate must be completed and returned to staff prior to your child's participation in the day camp program.

Complete Registration


Once your registration and transaction are complete, the following items will print out for your convenience. A Summer Playground/Teen Center Confirmation Receipt, a Deputy Director's Letter which must be signed and returned to program staff prior to participation in the program, and depending upon your answers to the prompts, the Participant Health-Medication Form or Maryland DHM Immunization Certificate.

Health/Medication Form


The Health/Medication Form (PDF) includes detailed information about a participant's health issue including illnesses, allergies, and any medication, emergency medical devices, or asthma inhalers that are taken during camp hours. If necessary, please return a completed copy to every program location prior to June 26.


Maryland Department of Health Immunization Certificate


The Health Immunization Certificate Form (PDF) details the participant's immunization history. It should be completed for any child who did not attend a public/private school in Prince George's County. If necessary, please return a completed copy to every program location prior to June 26. The form is also available in Spanish (PDF).