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9:30 AM - 1:30 PMDeposit: $25 (per month) non-refundable

(*We will pro-rate the registration fee based on the number of days your child attends per month.)

Cost: $25 per dayJune 11 - August 17

___ June 11(Soccer) ___ July 9 (Karate) ___ July 30 ___ June 12 ___ July 10 ___ July 31 ___ June 13 ___ July 11 ___ Aug 1(Science) ___ June 14 ___ July 12 ___ Aug 2 ___ June 15(Water Day) ___ July 13(Water Day) ___ Aug 3 (Water Day)

___ June 18 ___ July 16 ___ Aug. 6(Karate) ___ June 19 ___ July 17 ___ Aug. 7 ___ June 20(Soccer) ___ July 18 (Science) ___ Aug. 8 ___ June 21 ___ July 19 ___ Aug. 9 ___ June 22(Water Day) ___ July 20(Water Day) ___ Aug. 10 (Water Day

VBS ___ July 23 (Gymnastics) ___ Aug. 13June 25-29 ___ July 24 ___ Aug. 14

Register Online ___ July 25 ___ Aug. 15 (Gymnasticwww.bayleaf.org ___ July 26 ___ Aug. 16

*For children 6 weeks-5th grade. ___ July 27 (Water Day) ___ Aug. 17(Water Day

Bay Leaf Baptist Church12200 Bayleaf Church Rd

Raleigh, NC 27614

919.847.4477

www.bayleaf.org

6weeks - 5th grade

Summer 2012

Summer Camp Registration FormSummer at Bay Leaf for 6 weeks through 5th Grade!

We offer a half-day summer program from 9:30am to 1:30pm. In our program kids are able

to worship the Lord through Bible stories, crafts, music, age appropriate WATER SLIDE & plaSOCCER, basketball, Gymnastics, KARATE, Science Experimentsand other organized rec activities!

Our desire is to minister to your kids year-round. Go to www.bayleaf.org for year-round programs. We sto create a stimulating learning environment where your kids will be blessed and enriched!

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Please mark with a x which days you want your child registered.

If you would like for your child to attend the entire week, please mark all days in that week. Thank you.

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GENERAL INFORMATION

Childs Name:___________________________________ Name Called: ________________________________

Birthdate: __________________________________ Age: ________________________ M/F: _______________

Current School: ______________________________________________________________________________

Parent/Guardian Name: ________________________________________________________________________

Address: ___________________________________________________ Zip Code: ________________________

Home #: _______________________ Work #: ____________________ Cell #: __________________________

Email: ______________________________________________________________________________________

Medical or other information we need to know: (Please include any allergies, especially food allergies or specialneeds)

___________________________________________________________________________________________

*If you have already turned in a medical release form for Little Lambs you do not need to do another one.

nsurance Carrier: _______________________________ Policy Number: _______________________________

Name of Policy Holder: ________________________________________________________________________

Emergency Contact

Name: __________________________________ Relationship: __________________ Phone #: ____________

Name: __________________________________ Relationship: __________________ Phone #: ____________

Who may pick up your child at the end of camp each day: (Please list all names of those eligible)

___________________________________________________________________________________________

Other Information:

Do you attend Church or Sunday School? If so where: _______________________________________________

How did you hear about us? ____________________________________________________________________

Please Check, Sign, & Date: I DO give permission for my childs image to be used in public news media.

I DO give permission for my childs image to be used in the churchs media & blog

**This would include our Facebook Page for Preschool & Track-Out.**

I DO NOT give permission for my childs image to be used in any media or blog s.

Sign: _________________________________________ Date: __________________________

Follow us on Facebook to stay betterconnectedand up-to-date onweather delays, school functions, and MORE!

You can find us atwww.facebook.com/bayleafpreschoolandtrackout.