View
213
Download
0
Category
Preview:
Citation preview
S:\Summer Camp 2016\Summer Camp Packet\Summer Enrollment Form 2016.doc
CRÈME CHAMP CAMP SUMMER PROGRAM 2016
Enrollment in Crème Champ Camp is weekly. Please indicate which weeks you would like your child enrolled for summer camp by checking the box next to the corresponding week. Enrollment is limited and done on a first come, first serve basis. The $50.00 summer camp registration fee and the $75.00 tuition deposit are due by April 1, 2016. Crème Champ Camp will be open to the public for enrollment on April 1, 2016. The following is due by April 30, 2016 to secure summer camp enrollment:
♦ First months tuition ♦ Summer Camp Tuition Agreement form ♦ Completed file (new students only) ♦ Signed and completed Field Trip Permission forms
All summer camp fees and/or tuition are non-refundable.
Child’s Name______________________________________
Child’s Date of Birth_______________________ Child’s Age____________________
Last Grade in School Completed _______________________
Check here Week # Tuition* DATES THEMES � 1 T W Th F May 31 - June 3 Planet Crème � 2 M T W Th F June 6 - June 10 Backyard Science � 3 M T W Th F June 13 - June 17 Sports Zone � 4 M T W Th F June 20 - June 24 That’s Entertainment � 5 M T W Th F June 27 - July 1 All About Art � 6 T W Th F July 5 - July 8 Stars and Stripes � 7 M T W Th F July 11 - July 15 Animal Antics � 8 M T W Th F July 18 - July 22 Outdoor Adventures � 9 M T W Th F July 25 - July 29 Rockin’ Records � 10 M T W Th F Aug. 1 - Aug. 5 Wacky Water
Total Number of Weeks
*Please see enclosed Summer Camp Calendar for more information regarding weekly field trips and activities.
Parent Signature_____________________________________ Date_________________
CRÈME CHAMP CAMP TUITION AGREEMENT (Haynes Bridge)
Tuition
Weekly Camp Fees – Summer 2016 Two days (minimum attendance per week) $192 Three days $239 Four days $280 Five days $321 Note: A one-day attendance program is not available. If you attend only one day, you will be billed the two-day rate. 1. All field trips and in-school activities are included. 2. Tuition includes breakfast, morning/afternoon snacks and lunch.
Fees Existing families – A $75 non-refundable tuition deposit (applied to tuition). Includes one complimentary Summer camp T-shirts. New families – A $50 non-refundable registration and a $75 non-refundable tuition deposit (applied to tuition). Includes one complimentary Summer camp T-shirt.
The non-refundable registration fee and tuition deposit, Tuition Agreement, Enrollment Form, Emergency Form with Photograph, and any additional forms requiring signatures must be completed and returned to the front desk for Summer Camp enrollment to be confirmed. If your child is not currently enrolled and continues with the Après School (after school program) an additional $150 registration fee will be due when the 2016-2017 school year begins. Please be advised that all Summer Camp tuition and fees are non-refundable, days attending must be chosen by the 15th of the previous month to guarantee field trip placement, and changing/switching of days is not allowed once billing has been processed. The balance of the weeks chosen will be billed on the first day of the appropriate month. Child’s Name_____________________________________ Date of Birth____________________________ Parent/Guardian Name (print)_________________________________________ Email_________________________________ Mother Phone (W)_________________________ (H)_______________________ (M)_______________________ Father Phone (W)_________________________ (H)_______________________ (M)_______________________ Home Address _______________________________City, State_____________________ Zip______________ Parent/Guardian Signature _______________________________________________ Date _____________________ Accepted: Executive Director (or designee) ___________________________________ Date _____________________
EMERGENCY FORM
Child’s Name:________________________________________ Birth Date:______________________
Address:______________________________________________ Home Phone: ___________________ City, State, Zip_________________________________________ Enrollment Date:_________________ Mother’s Name:________________________________________ Employer:______________________ Work Hours:___________________ Work #:____________________ Cell #:______________________ Father’s Name:_________________________________________ Employer:______________________ Work Hours:___________________ Work #:____________________ Cell #:______________________
Authorized person to whom child may be released if parent is unavailable
Name:_______________________________________________ Relationship to Parent:____________
Address:______________________________________________ Driver’s License #: _______________
Home #:______________________ Work #:____________________ Cell #:_______________________
Transportation Permission
I give my permission for my child to be transported for field trips that will be taken periodically as part of the overall Education Program. All children attending field trips must be four (4) years old or older (unless otherwise specified by State Regulations). Parents Signature:______________________________________________ Date:____________________
Medical Information Medical Facility the Center Uses:_____________________________ Address: ________________________________ Food and/or Drug Allergies:________________________________________________________________________ Medication(s):___________________________________________________________________________________Dosage and Frequency:____________________________________________________________________________ Child’s Special Needs and Conditions: ________________________________________________________________ Physician:_________________________________________ Phone:_______________________ Hrs:_____________ Address:________________________________________________________________________________________Hospital preferred for emergency treatment:____________________________________________________________ Health Insurance Company:___________________________________________ Policy #:______________________
Emergency Release Should my child become ill or suffer an accident, I hereby authorize the school named above to administer, call for emergency care, or secure the necessary medical attention as may be deemed necessary by the school. I understand that my child would be transported to the nearest hospital facility in the event of a serious accident. I give permission to secure emergency medical and/or surgical treatment for the above named minor child while in the care of the above named school. I understand that an effort will be made to contact me or my designee(s), if possible, before any action will be taken. I also understand that any expense incurred will be accepted by me.
Parent’s Signature:____________________________________________ Date:_____________________
Authorized person to be notified in emergency when parents are unavailable Name:_____________________________________________________ Relationship to Parent:__________________ Address:________________________________________________________________________________________ Home #:________________________ Work:_______________________ Mobile:__________________
Subscribed and sworn to (or affirmed) before me this ______ day of ________ year __________. Signature of Notarial Officer___________________________ My commission expires: ____________________.
Attached Child’s Photo Here
Notary Seal
Rocky Mountain Sunscreen Parental Consent Form
Attention Parents:
Crème de la Crème and Rocky Mountain Sunscreen (RMS) are dedicated to children’s year-round sun protection. It is the policy of Crème de la Crème to apply sunscreen to all exposed skin when children are engaged in outdoor activities. It is our sincere intent to provide your child with the best in sun protection lotion that is effective, safe, and designed for ease of application.
Rocky Mountain sunscreens are: Broad Spectrum UVA / UVB, Very Water Resistant (Waterproof), Non-Staining, Non-Comedogenic, Gluten Free, Paba free, Fragrance free, and Hypoallergenic.
The ingredients listed below are standard chemicals used in only top quality sunscreens. Please take a moment to insure your child is not allergic to any of these ingredients.
SPF 35: ACTIVE INGREDIENTS: OXYBENZONE FREE Octinoxate 7.5%, Octisalate 5.0%, Octocrylene 10.0%, Titanium Dioxide 1.3%
INGREDIENTS: Aloe Barbadensis Leaf Juice, Cetyl Alcohol, Dicaprylyl Maleate, DMDM Hydantoin (and) Iodopropynyl Butylcarbamate, Hydrogenated Polyisobutene, Hydroxyethyl Acrylate/Sodium Acryloyldimethyl Taurate Copolymer (and) Isohexadecane (and) Polysorbate 60, Stearic Acid, Trilaureth-4 Phosphate, Water. Free of Carbohydrates, Casein, Corn products, Fragrance, Gluten, Glycol, Nut oil, parabens, silicones, soy and sugars.
A complete list of all ingredients is available by visiting Rocky Mountain Sunscreen’s website, www.rmsunscreen.com and clicking on “Product Specifications,” or via written request to RMS’s office, Rocky Mountain Sunscreen, 14700 West 66th Place Suite #2, Arvada, CO 80004
Please check, sign, and date the authorization form below.
_____ YES I authorize Crème de la Crème to apply Rocky Mountain Sunscreen SPF 35 to
________________________________ for all of his/her outdoor activities.
(Child’s Name)
_____ NO I have read the above information and do not authorize use of Rocky Mountain Sunscreen, I will supply an
appropriate sunscreen product, as specified in the Crème de la Crème sunscreen policy, for
________________________________ for all of his/her outdoor activities.
(Child’s Name)
Parent Signature: ________________________________________ Date: ___________________
CATCHECRÈMER CREEK WATERWORKS CO.
CONSENT FORM
I hereby allow my child, _____________________________, to use the facilities of the
Catchecrèmer Creek Waterworks Co. located on the premises of Crème de la Crème
while my child is in the care of this school. My emergency contact information is on file
with Crème de la Crème. This consent is valid for one year from the date of signature.
______________________________________________ _________________ Parent Signature Date ______________________________________________ _________________ Parent Signature Date
1
MMaayy
Theme Monday Tuesday Wednesday Thursday Friday
2 3 4 5 6
9 10 11 12 13
16 17 18 19 20
23 24 25 26 LAST DAY OF
SCHOOL FULTON COUNTY!
27 SUMMER CAMP
KICK-OFF PARTY
PLANET CRÈME
30 CRÈME CLOSED MEMORIAL DAY
31 CHILDREN’S
MUSEUM
CRÈME CHAMP CAMP Summer Program 2016
1
JJUUNNEE
Theme Monday Tuesday Wednesday Thursday Friday
PLANET CRÈME
1 FERNBANK MUSEUM
2 KIDS TRIX MAGIC SHOW @
CRÈME
3 CHAMBERLAIN’S
CHOCOLATE FACTORY
BACKYARD SCIENCE
6 TELLUS SCIENCE
MUSEUM
7 DUNWOODY NATURE
CENTER
8 SCIENCE: A TOUCH OF
MAGIC @ CRÈME
9 WILLS PARK &
MENCHIE’S
10 GA BUBBLE MAN
@ CRÈME
SPORTS ZONE
13 COLLEGE
FOOTBALL HALL OF FAME
14 AMAZING ATHLETE’S
@ CRÈME
15 MOVIE & MINI GOLF
16 ATLANTA BRAVES
17 CRÈME OLYMPICS & KONA ICE @ CRÈME
THAT’S
ENTERTAINMENT
20 WORLD OF COCA-
COLA
21 LEGOLAND
22 ATLANTA DREAM
23 THE DRAGON KING
24 WATER PARK @
SUGARLOAF’S CRÈME
ALL ABOUT ART
27 THE CANDLE
STATION @ CRÈME
28 ART BARN
29 OUT OF THE BOX ART
STUDIO
30 T-SHIRT TIE DYE @
CRÈME
CRÈME CHAMP CAMP Summer Program 2016
1
JJUULLYY
Theme Monday Tuesday Wednesday Thursday Friday
ALL ABOUT ART
1 ALL FIRED UP
STAR’S & STRIPES FOREVER
4 CRÈME CLOSED
5 SKYZONE ROSWELL
6 ALL AMERICAN
LUNCH & KONA ICE @ CRÈME
7 SPLASH N’ PLAY AT
RIVERSIDE PARK
8 STARS & STRIKES
BOWLING & LASER TAG
ANIMAL ANTICS
11 ZOO ATLANTA
12 WATER PARK @
SUGARLOAF’S CRÈME
13 MR. GREG’S REPTILE
SHOW @ CRÈME
14 FUN JUNCTION USA
15 MOVIE & MINI GOLF
OUTDOOR
ADVENTURES
18 CHATTAHOOCHEE NATURE CENTER
19 X-DRENALINE
20 NORTH GEORGIA
ZOO
21 WILLS PARK & MENCHIE’S
22 SPLASH N’ PLAY AT
RIVERSIDE PARK
ROCKIN’ RECORDS
25 MISS GAIL’S JAM BAND @ CRÈME
26 LET’S ROLL SKATE &
FUN CENTER
27 STARS & STRIKES
BOWLING & LASER TAG
28 CRÈME CAMP TALENT SHOW
PRACTICE & KONA ICE @ CRÈME
29 CRÈME CAMP
TALENT SHOW @ CRÈME
CRÈME CHAMP CAMP Summer Program 2016
1
AAUUGGUUSSTT
Theme Monday Tuesday Wednesday Thursday Friday
WACKY WATER WEEK
1 STONE MOUNTAIN
PARK RIDE THE DUCKS
2 BUCCANEER COVE @ MALIBU GRAND PRIX
3 SPLASH N’ PLAY AT
RIVERSIDE PARK
4 ASTRO JUMP WATER
SLIDE @ CRÈME
5 LAST DAY LUAU @
CRÈME
8
BACK TO SCHOOL FULTON COUNTY!
9 10 11 12
15 16 17 18 19
22 23 24 25 26
29 30 31
CRÈME CHAMP CAMP Summer Program 2016
Recommended