CRÈME CHAMP CAMP SUMMER PROGRAM 2016 have read the above information and do not authorize use of Rocky Mountain Sunscreen, I will supply an appropriate sunscreen product, as specified

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


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


1

JJUULLYY


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


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


1

AAUUGGUUSSTT


WACKY WATER WEEK

1 STONE MOUNTAIN

PARK RIDE THE DUCKS

2 BUCCANEER COVE @ MALIBU GRAND PRIX


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


Documents

CRÈME CHAMP CAMP SUMMER PROGRAM 2016 have read the above information and do not authorize use of Rocky Mountain Sunscreen, I will supply an appropriate sunscreen product, as specified