WEECare Preschool SUMMER register for All 5 Days camps€¦ · SUMMER WEECare Preschool &...
Transcript of WEECare Preschool SUMMER register for All 5 Days camps€¦ · SUMMER WEECare Preschool &...
S U M M E R
WEECare Preschool & Kindergarten
camps LIMITED SPACE
ages 2 - 6 years old 9:00am - 1:00pm daily
$45 PER DAY Or SAVE when you
register for All 5 Days For ONLY $200
June 13
SPACE CAMP!
July 11
Under the Sea!
July 25
BUGS!
August 8
PETS!
June 27
OutDoor
Adventure!
Name of Camper: ________________________________________________________
Age: ______________ DOB: _______________ Potty Trained? _____ Y _____ N
Parents’ Names: _________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Phone: ____________________________ Email: ______________________________
Emergency Contact/Phone: _______________________________________________
Persons authorized to pick up camper (other than parents):
_______________________________________________________________________
Persons NOT authorized to pick up camper:
_______________________________________________________________________
2017 Summer Camp REGISTRATION
SUMMER CAMP DATES:
Cost of Camp per camper is $45/day or $200/all 5 days
A $45 non-refundable deposit per camper holds spot
Registration is due with full payment by May 15.
Registrations at the door will not be accepted.
Tuesday, June 13 — Space Camp
Tuesday, June 27 — Outdoor Adventure
Tuesday, July 11 — Under the Sea
Tuesday, July 25 — BUGS!
Tuesday, August 8 — Pets
TOTAL COST: $_________________
Backside of Registration Form must be completed with Parent Signature.
WEECare PRESCHOOL & KINDERGARTEN
WEECare Preschool & Kindergarten 2017 SUMMER CAMP Registration
______________________________________________________________________________________________________________________
IMPORTANT
In order to reserve your child’s spot for Summer Camp, a minimum of $45 non-refundable deposit with a completed registration form is due
immediately. Outstanding balances must be paid by May 15, 2017.
EMERGENCY AUTHORIZATION
Parents/guardian will complete and return an Emergency Medical Authorization Permit Form prior to the start of camp. Parent/guardian under-
stands that they will provide permission to the physician selected by the camp leader to hospitalize and secure proper treatment for the camper if
parent/guardian cannot be reached in the event of an emergency. Parent/guardian will be fully responsible for any costs of such treatment, even
if not covered by insurance.
CONSENT TO CONDITIONS
Drop Off Time: 9:00am (Parents may drop off via carpool line at the main foyer doors)
Pick Up Time: 1:00pm (Parents must park and come in to sign out child(ren)
Lunch: Students will supply their own disposable lunch daily. Additional snacks will be provided by the program.
Supplies: Students should bring a water bottle, sunscreen, and an extra change of clothes, and diapers (if applicable) each day.
PARENT/GUARDIAN PERMISSION
My signature below indicates that I have the legal authority to sign up the child(ren) named on this form and the information listed is complete
and correct. I further understand that this is an application and the named child(ren)’s participation is contingent upon space being available in
the program. Once the application is confirmed, my deposit becomes non-refundable. All additional payments and forms are due prior to the first
day of camp.
Parent/Guardian
Name_______________________________________________________________
Signature______________________________________________________________________________ Date ____________________________
WEECare Preschool & Kindergarten EMERGENCY MEDICAL AUTHORIZATION PERMIT
Whenever my child is involved in a school activity and I am unavailable or otherwise unable to provide authorization directly, I do hereby grant to
the school director or his/her designee the authority to act for me and to provide any required consents and authorization for the delivery of
emergency medical care, diagnoses, and treatment, including surgical intervention, if necessary, on behalf of my minor child listed below and to
do all other necessary things as I might or could do to provide for the child’s health and safety, if I were present.
Child’s Name: _________________________________________________________________________________________________________
(Last) (First) (Middle)
School: ____________WEE CARE PRESCHOOL___________ Class:______2017 SUMMER CAMP_________ Teacher:_______________________
Parent or Guardian Names:______________________________________________________________________________________________
Home Address:________________________________________________________________________________________________________
(Street) (City) (State) (Zip)
Mother’s Employer: _______________________________________ Father’s Employer: _____________________________________________
(Phone No.) (Phone No.)
Doctor Preferred:________________________________________________________________________________________________________
(Name) (Address) (Phone No.)
Dentist Preferred: _______________________________________________________________________________________________________
(Name) (Address) (Phone No.)
Insurance Company:______________________________________________________________________________________________________
(Insurance Identification No.)
Allergies:_______________________________________________________________________________________________________________
Medical Conditions:_______________________________________________________________________________________________________
Previous Operations / Hospital Confinements:__________________________________________________________________________________
Authorized Signature: _____________________________________________________________________________________________________
(Parent / Guardian) (Date)