Online Registration

To complete the registration process, you must first agree to the Johnny B’s Inc. Discipline and Behavior Management Policy. And, after completing this registration form, a staff member will contact you to discuss your position on the waiting list. Completing this form does not guarantee a space in Johnny B’s Inc.

Step 1 of 8 - Camper Information

Discipline and Behavior Management Policy

Our program advocates a positive guidance and discipline policy with an emphasis on positive reinforcement, redirection, prevention and the development of self-discipline. We remind participants that the program rules are established for safety and to ensure that we have a common standard of behavior. Our staff work with participants to establish standards of acceptable behavior. Good behavior and cooperation are expected of all participants.

Shared Responsibility

The staff at Johnny B’s suggest positive alternatives to unacceptable behavior before it gets out of control. Parents, participants and staff work together to develop and promote responsible behavior during attendance at the program. Parents will be notified if their child is having difficulty following the safety rules; parents may be requested to attend a conference with the Director. It is our sincere desire to work with parents for the benefit of their child.

Participants are expected to comply with the program rules and obey and be respectful of the program staff. Parents are expected to cooperate with and support the staff in maintaining and encouraging acceptable behavior for their children. Staff must maintain the established standards of behavior needed to assure a safe, positive and fun atmosphere.

Director and Assistant Director Responsibilities

The Director is responsible for setting the standards of the Behavior Management Policy and for supervising the staff and assuring the standards are followed on a daily basis. The Director or Assistant Director are responsible for notifying parents of serious behavioral issues that affect the safety of their child, another child or the staff ( for example, fighting, threatening to harm another camper/staff, throwing rocks). The Director or Assistant Director are responsible for notifying parents if their child uses inappropriate language, engages in vandalism or stealing while at day camp.

Day Camp Behavior Standards
All campers are expected to:
- Respect all persons’ rights and property. Bullying is not tolerated at Johnny B’s Inc. Staff are trained to recognize bullying and to teach participants that it is not acceptable and is to be reported to the staff.
- Follow instructions given by our staff in order to ensure a safe and efficient day of fun activities.
- Behave in a safe and reasonable manner.
Profanity: The use of profanity is not acceptable or tolerated at day camp. Parents will be notified if their child uses profanity or offensive language. Children who use profanity or offensive language will be given 1 warning. If the child uses profanity again, he/she will immediately be given a time out, 1 minute per year of age. Continued use of profanity or offensive language can result in expulsion from the program.

Sexual/Religious/Political/Violent Discussions: The topics of sex, religion, politics, race and violence are inappropriate at Johnny B’s Inc. Those topics are to be discussed at home with parents. Johnny B’s Inc. is a recreational program and holds no affinity with any political, religious, sexual, or racial group or activist movement. Activism is prohibited at camp. Children promoting activism of any kind will be subject to the consequences of the behavior management policy. Children engaging in inappropriate discussion topics will be subject to the consequences of the behavior management policy.

Vandalism: Children who damage or lose property or equipment belonging to the program may be asked to replace or repair the damaged property or equipment. Children who vandalize property will be given a time out immediately, 1 minute per year of age. Their parents will be contacted by the Director or Assistant Director. Vandalism may result in expulsion from the program.

Fighting, throwing rocks or sticks: Children who fight or threaten to cause harm to another person, or throw rocks or sticks or sand will be referred to the Director or Assistant Director. They will be given a time out immediately, 1 minute per year of age. Their parents will be contacted by the Director or Assistant Director. These types of behaviors may result in expulsion from the program.

Weapons: Weapons such as knives, slingshots, darts, clubs, chains, firearms, are not permitted. Any child who has an object considered to be a weapon will be referred to the Director or Assistant Director. The parents will be notified immediately, the weapon will be confiscated and held in a secure place as determined by the Director or Assistant Director. The child will be given a timeout, 1 minute per age. Bringing a weapon to the program may result in expulsion from the program.

Alcohol and illegal substances: These are not allowed at the program and will be confiscated immediately. Parents will be notified by the Director or Assistant Director to pick up their child immediately. Bringing alcohol or illegal substances to the program may result in expulsion from the program.

Defiance and Repeated Disruptions: Children who defy the authority of the staff by refusing to follow the rules, refusing to take time out or accept other consequences as outlined in the discipline policy listed below, may be expelled from the program.

Counselors at Johnny B’s will:
1. Discuss the rules with participants and identify out of bounds areas.
2. Discuss the consequences of not following the rules:
  • Time out or quiet time
  - First time: 1 minute per year of age
  - Second time: 20 minutes
  - Third time: Parent notified, possible loss of privileges, possible additional time out, possible Unacceptable Behavior Notice (UBN)
  - Fourth time: Parent must pick child up immediately
  • Restriction from activity
  • Restriction to adult supervision
  • Conference with the Director and parent
  • Removal from the program: If a participant receives 3 UBN’s they will no longer be allowed to participate in the program.
  • Extreme issues are discussed with the Advisory Board and may result in immediate expulsion from the program. The Director will communicate the recommendation of the Advisory Board to the parents.
3. Enforce all rules at all times, without malice, and be consistent in application.
4. Inform the Director or Assistant Director of all disciplinary measures
5. Never allow discipline to include:
  • depriving a participant of food or restroom use
  • placing a child alone without supervision
  • subjecting a child to ridicule, shaming or threat
  • corporal punishment including spanking, slapping, striking, pinching, biting, kicking, pulling, hitting, or washing out the mouth with soap or any unpleasant substances
6. Restraint of a participant is only to be used if they are a danger to themselves, a danger to others or property. Participants that need to be redirected or assisted may be touched gently on the shoulder, upper arm or hand based on a case by case situation.
7. Conduct a periodic evaluation of the program/staff/participant groups to ensure that the program environment is not contributing to behavioral problems.
I agree to Johnny B's discipline and behavior management policy*
I agree and want to continue the registration process.
I understand that I must agree to Johnny B's discipline and behavior management policy to continue the registration process.

In completing this multi-page form, you will be asked a series of questions and asked to provide information that will better help us serve you and your child. Once you complete each page, it will be saved as you click on the "Continue" button at the bottom of each page. Please complete the items on each page. Thank you! If you need to download an electronic version of the form, please click here.
Please Select One of the Following Programs to Register For:*
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Reg Status
Camper Name*
First Middle Last
Gender*
- Male
- Female
School Name*
Teacher's Name*
Birth Date*
MM slash DD slash YYYY
Age on Arrival at Camp:*
Please enter a number from 4 to 12.
Dates will attend camp: Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Camper's Home Address*
Address Line 2
City*
State*
Zip Code*

Parent/Guardian with legal custody to be contacted in case of illness or injury.
Parent/Guardian Name*
First Last
Relationship*
Phone*
Email*
Street Address*
Address Line 2
City*
State*
Zip Code*
Second Parent/Guardian or other emergency contact
Parent/Guardian Name 2*
First Last
Relationship*
Phone*
Email*
Additional emergency contact in event parent(s)/guardian(s) can not be reached.
Additional Emergency Contact Name*
First Last
Relationship
Phone
Email

Immunization History
Provide the month and year for each immunization. Starred (*) immunizations must be current. Copies of immunization forms from health-care providers or state or local government are acceptable; you can upload an image or pdf of the documentation below.
Diphtheria, Tetanus, Pertussis (DTaP) or (TdaP) *
DTaP Dose 1
MM slash DD slash YYYY
DTaP Dose 2
MM slash DD slash YYYY
DTaP Dose 3
MM slash DD slash YYYY
DTaP Dose 4
MM slash DD slash YYYY
DTaP Dose 5
MM slash DD slash YYYY
Tetanus Booster (dT) or (TdaP) *
TdaP - Most Recent Dose
MM slash DD slash YYYY
Mumps, Measles, Rubella (MMR) *
MMR Dose 1
MM slash DD slash YYYY
MMR Dose 2
MM slash DD slash YYYY
MMR - Most Recent Dose
MM slash DD slash YYYY
Polio (IPV) *
IPV Dose 1
MM slash DD slash YYYY
IPV Dose 2
MM slash DD slash YYYY
IPV Dose 3
MM slash DD slash YYYY
IPV Dose 4
MM slash DD slash YYYY
Haemophilus Influenzae Type B (HIB) *
HIB Dose 1
MM slash DD slash YYYY
HIB Dose 2
MM slash DD slash YYYY
HIB Dose 3
MM slash DD slash YYYY
HIB Dose 4
MM slash DD slash YYYY
Pneumococcal (PCV)
PCV Dose 1
MM slash DD slash YYYY
PCV Dose 2
MM slash DD slash YYYY
PCV Dose 3
MM slash DD slash YYYY
PCV Dose 4
MM slash DD slash YYYY
Hepatitis B
HEP B Dose 1
MM slash DD slash YYYY
HEP B Dose 2
MM slash DD slash YYYY
HEP B Dose 3
MM slash DD slash YYYY
Hepatitis A
HEP A Dose 1
MM slash DD slash YYYY
HEP A Dose 2
MM slash DD slash YYYY
Varicella (Chicken Pox)
CP Dose 1
MM slash DD slash YYYY
CP Dose 2
MM slash DD slash YYYY
Had Chickenpox?*
- Yes
- No
Date had Chickenpox
MM slash DD slash YYYY
Meningococcal Meningitis (MCV4)
MM Dose 1
MM slash DD slash YYYY
Tuberculosis (TB) Test
TB Test Date
MM slash DD slash YYYY
Tuberculosis (TB) Test Result
- Negative
- Positive
If your camper has not been fully immunized, please sign the following statement:*
I understand and accept the risks to my child from not being fully immunized.
- Yes, I understand.
Relationship to Camper*
Date*
MM slash DD slash YYYY

Please select the date that you acknowledged the immunization risk above.
Immunization History - File Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB.
Copies of immunization forms from health-care providers or state or local government are acceptable in the following formats: jpg, gif, png, & pdf. Files can not exceed 1 MB.

Release of Camper OM-13 and Payment Policy
Parents have entrusted us with their most precious possession - their children. We must do all we can do to provide them the best care while they are our responsibility. Therefore, the following guidelines will be followed at Johnny B's Inc. day camp:
1. All campers are to be released only to an authorized person. Parents/Guardians must complete and sign a form (see below) authorizing release of the camper to anyone other that the custodial parent or legal guardian. Identification will be required for release of campers to an authorized person.
2. If a custodial parent request that a camper not be released to a noncustodial parent, such a request must be in writing. If there is a restraining order that prohibits a parent from having contact with a camper, a copy of the current restraining order must be provided to Johnny B's Inc. to keep on file.
3. When a last minute change occurs in who will be picking up a camper, the new instructions are to be verified with the camp director for an authorized person.
4. No camper may leave camp at any time without prior authorization from the custodial parent and the camp director.
No-Shows/Absentees
Daycamp: Campers are to be signed in by a counselor upon arrival; campers must be signed out by a counselor before leaving each day. The adult picking up the camper must notify a counselor that their child is leaving for the day. Parents are asked to notify the camp if a child is ill or will not be attending as expected. Camp personnel will attempt to call parents/guardians and/or emergency contacts if campers are not signed in as expected.
Authorized Release of Camper
Child's Name*
Name # 1*
I hereby authorize the following persons to pick up my child from Johnny B's Daycamp:
Relationship*
Phone*
Name # 2*
Relationship*
Phone*
Authorized by Parent/Guardian*
Enter your Name here.
Date*
MM slash DD slash YYYY

Please enter the date you completed this authorization form.
Authorizing Email*
Enter Email Confirm Email
Phone (Work)*
Phone (Cell)*
Phone (Home)*
Acknowledgement/Acceptance of Johnny B's Inc. Payment Policy.
I understand fees are due on the 15th of each month. I am aware of and agree to pay a $25.00 late fee for payments not received on time. I agree and understand that if I am more than 3 day s late with the monthly payment, my child will not be allowed to participate in Johnny B's. I understand the drop-off time for vacation daycamp is between 7:00-9:30 am. I understand pick-up time is no later than 6:15. I am aware of and agree to pay, the $5.00 per 15 minute late charge to be paid at the time I am picking up my child. I understand if my child is consistently picked up late, I will receive notification that my child may no longer attend Johnny B's.

Lastly, I have read and agree to all payment policies terms. I understand that I need to provide 30 days’ notice before my child or children's last day of attendance. I understand that failure to do so will result in a possible $100 fee, forfeit of deposit, and may potentially reflect negatively on my credit report.
Payment Policy Acknowledged and Accepted by Parent/Guardian*
Enter your Name here.
Date*
MM slash DD slash YYYY
Assumption of the Risk & Waiver of Liability Form Relating to Coronavirus/COVID-19
Johnny B’s Inc. cannot guarantee that you or your child(ren) will not become infected with COVID-19 while using Johnny B’s Inc.’s childcare services. Participation in our programs could increase your and your child(ren)’s risk of contracting Coronavirus aka COVID-19. The disease is highly contagious and impossible to effectively prevent or detect.

The staff of Johnny B’s Inc. do not wear masks while engaged in outdoor physical activities with your children because that is a demanding activity which elevates CO2 production, which is toxic when masks are worn.

ASSUMPTION OF RISK: I acknowledge that I have read the above concerning COVID-19. I acknowledge that an inherent risk of exposure to COVID-19 exists in any public or private place, whether or not people are present. By participating in a program offered by Johnny B’s Inc., whether as a staff member, volunteer, parent, guardian or child, I voluntarily assume all risks related to exposure to COVID-19 and agree not to hold Johnny B’s Inc., or any of its affiliates, directors, officers, employees, agents, contractors, or volunteers liable for any illness or injury.

WAIVER OF LIABILITY: On my behalf, and on behalf of my child(ren) and heirs, I hereby release, covenant not to sue, discharge, and hold harmless Johnny B’s Inc., its employees, agents, and representatives, of and from the all liabilities, claims, actions, damages, costs or expenses of any kind (“Claims”) arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Johnny B’s Inc., its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation at Johnny B’s Inc.

Download the Assumption of the Risk & Waiver of Liability Form Relating to Coronavirus/COVID-19
Coronavirus/COVID-19 - Assumption of the Risk and Waiver of Liability Acknowledged & Accepted by:*
Enter your Name here.
Johnny B’s Policy Requiring Face Coverings Relating to Coronavirus/COVID-19

Subject to the following provisions, Johnny B’s requests staff members, parents, and children to wear face coverings. All face coverings (whether disposable or reusable) must:
- Be made with at least 2 layers of breathable material,
- Fully cover the nose and mouth and secure under the chin,
- Fit snugly but comfortably against the side of the face,
- Be secured with ties or ear loops and allow the Guest to remain hands-free.
Johnny B’s requires all its staff members to wear face coverings unless they are eating or engaged in energetic physical activity.

Johnny B’s requires all children to wear face coverings, unless they are exempted under California Department of Public Health guidance (CDPH), or they are eating or engaged in energetic physical activity. Johnny B’s recognizes that the CDPH exempts at least two categories of persons:
1. Persons with a medical condition, mental health condition, or disability that prevents wearing a face covering. This includes persons with a medical condition for whom wearing a face covering could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a face covering without assistance.
2. Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication.
Johnny B’s Inc. wants to empower children and their parents to take responsibility for who they are and how they are. Consistent with that mission, we will not inquire into a child’s reasons for not wearing a mask, nor draw any attention to their decision not to wear a mask. We request that parents instruct their children to wear a mask unless they are exempt.

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We have taken enhanced health and safety measures—for you, your children, and our staff.

An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and persons with underlying medical conditions are especially vulnerable.

By attending a Johnny B’s activity, you voluntarily assume all risks related to exposure to COVID-19.

Help keep our program healthy. Be responsible.

Download the Johnny B’s Policy Requiring Face Coverings Relating to Coronavirus/COVID-19
Johnny B’s Policy Requiring Face Coverings Relating to Coronavirus/COVID-19 Acknowledged & Accepted by:*
Enter your Name here.
PARENT OR GUARDIAN ADDITIONAL AGREEMENT (Must be completed for participants under the age of 18)

In consideration of my child (Input minor's name below) being permitted to participate in this activity, I further agree to indemnify and hold harmless Johnny B’s Inc. from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor.
Minor's Name*
Enter Minor's Name here.
Parent or Guardian Additional Agreement Acknowledged & Accepted by:*
Enter your Name here.
Johnny B's Inc. may use my child's photo for promotional purposes.
Photo Release - Accepted by Parent/Guardian*
Enter your Name here.
Date*
MM slash DD slash YYYY

Step 1 of 8 - Camper Information

Discipline and Behavior Management Policy

Shared Responsibility

Director and Assistant Director Responsibilities

Day Camp Behavior Standards

Johnny B’s Inc.