Camp Voices 2017ENROLLMENT APPLICATION

(Conyers)

Age 4May 30th – July 28, 2017

6:00 AM - 7:00 PM

**Early Bird Registration Special**Deadline is May 15, 2017

VOF Members Non-MembersFREE $25.00

Camp Registration after May 15, 2017VOF Members Non-Members

$25.00 $50.00Weekly Camp Fee $105.00 per child

Activity Fee Paid Per Event

1600 Irwin Bridge Rd., Conyers, GA 30012Phone: 678-374-3500 Fax: 678-374-3505

SUMMER CAMP ENROLLMENT APPLICATION

Today’s Date______________ Child’s T-Shirt Size S M L XL Adult Sizes S M L XLFirst Time Attending? Y___N___Member___Member No.________Non-Member___

Camper’s Full Name: _______________________________ ________________ Age: _________ DOB: ___________________Last First ( ) Boy ( ) Girl PresentAddress________________________________________________________________________________ Street City State Zip Code

Mother: _______________________________________________________________________________ Last Name First Name Cell

Father: _______________________________________________________________________________Last Name First Name Cell

EmailAddress________________________________________________________________________________ Mother’s Email Father’s Email

Parent Address (if living separately): ( ) mother ( ) father

______________________________________________________________________________________Street City State Zip Code

Emergency Contact ______________________________________________________________________ Last Name First Name Relationship Cell

State any mental, emotional or physical handicaps, which may affect his/her activities or progress during summer camp (all information is confidential):

______________________________________________________________________________________Has he/she had any psychological testing? (I.e. Attention Deficit Disorder (ADD); Hyper Activity Disorder, Anger Disorder): ( ) Yes ( ) No If yes what were the results?______________________________________________________________________________________

Person(s) authorized to pick-up child:Name______________________________ Relationship______________________________Name______________________________ Relationship______________________________Name______________________________ Relationship______________________________

OFFICE USE ONLY:Date Received: __________ Accepted By: __________ PIN Issued: Y__ N__ #______Amount Paid: ___________ App Entered: __________ IES Form Submitted: Y__N__ Received: T-Shirt________ Promo Item __________ NOTES__________________

Parental Payment Contract

I (We) reserve enrollment for ______________________________________________________________in Voices of Faith “Camp Voices.” I agree to pay a non-refundable registration fee.

I further agree to pay weekly fees of $105 per child on Monday of each week by 7:00 p.m. I understand that a late fee of $15.00 will be assessed after this time. I further, understand that nonpayment of weekly fees for (1) week will relinquish my child’s place at Camp Voices and that he/she will not be able to return to camp until all fees and outstanding balances are paid in full.

Parents will not be charged for temporary absences (vacation) or illness to hold a child’s place in Camp Voices. When campers are going to be absent or withdraw from Camp Voices, we ask that a one week written notice be given.

Camp Voices will NOT refund any monies for partial weeks of the child’s attendance. Attendance for one day constitutes a full week and no monies will be refunded.

Payment Breakdown Registration Fee VOF Member $25.00 per child after 5/15/2017

Non-Member $50.00 per child after 5/15/2017The registration fee is non-negotiable and must be paid before camp begins.

Summer Camp T-shirt $10.00 per childThe t-shirt fee must be paid at the time of registration.

Camp Voices Weekly Fee $105.00 per childThe weekly fee covers the administrative portion of summer camp. This includes but is not limited to food, supplies and staff salaries. This fee is non-negotiable and must be paid weekly.

Activity Fee Paid Per Activity [not to exceed $10 per activity]

The field trip/activity fees are not included in the weekly fee. Field Trip & Activity fees must be paid before any camper is allowed to participate in any camp activities. Campers who do not pay for the scheduled activity must find alternate care for the day.

Parents Please Note: If we experience a pattern of behavioral issues with your camper, they may be 1) denied the opportunity to participate in camp activities or 2) required to provide an adult chaperone. The chaperone is responsible for all fees related to the scheduled activity.

I understand the pick-up time for my child is 7:00 p.m., therefore beginning at 7:01 p.m., I am considered late and will be assessed a $2.00 per minute charge which is payable at the time of pick-up.

By signing below, I acknowledge that I fully understand my obligation for my child and agree to the terms in this contract.

___________________________________________________ _______________ Parent Signature Date

VOICES OF FAITH SUMMER CAMP PARENTAL AGREEMENT

VOF summer camp agrees to provide child care for ____________________________________Monday through Friday, from 7:00 a.m. – 7:00 p.m. from May 30th through July 28, 2017.

Medication may be administered during summer camp on a limited basis (Prescription only).

My child will not be allowed to leave the facility without being escorted by the parent/guardian, persons authorized by the parent/guardian or Summer Camp personnel.

I acknowledge that it is my responsibility to keep my child’s records current and to give notice of significant changes as they occur (i.e.: telephone numbers, work location, emergency contacts, etc.)

VOF summer camp agrees to keep me informed of any incidents, including illnesses, injuries, death and/or exposure to communicable diseases, which could possibly include or affect my child.

VOF summer camp agrees to obtain written authorization from me before my child participates in routine transportation, field trips, or special activities away from the facility.

My child ( ) will ( ) will not participate in all meal plans. If not, nutritious meals that meet USDA standards will be provided by: _______________________________________.

I have received, read and agree to abide by the policies of Voices of Faith Summer Camp 2017.

(Parent/Guardian)Signature______________________________ Date: _____________

CAMP VOICES EMERGENCY MEDICAL AUTHORIZATION

_______________________________________ _____________________ Child’s Name Date of Birth

Should my child suffer an injury or illness while in the care of Camp Voices and the facility is unable to contact me immediately, it shall be authorized to secure such medical attention and care for the child that are deemed necessary such as calling 911. I agree to keep the facility informed of changes in telephone numbers, etc. where I can be reached.

The facility agrees to keep me informed of any incidents requiring professional medical attention involving my child.

Child’s primary source of Health care is:

___________________________________________ _____________________________ Physician/Clinic Name Telephone Number

Known medical conditions (i.e. diabetes, asthma, drug allergies): If no known conditions please write the word “NONE.”

Known food allergies:

Parent/Guardian Signature ___________________________________________ Date ________________

Daytime Telephone ____________________________ Cellular __________________________________

Vehicle Emergency Medical Information

Child's Name _________________________________ Date of Birth _______________

Address ________________________________________________________________

Father's Name ___________________________________________________________

Home Phone ___________________________ Work Phone ______________________

Mother's Name __________________________________________________________

Home Phone ___________________________ Work Phone ______________________

Person to notify in case of an emergency and parents cannot be reached:

Name ________________________________________ Phone ___________________

Child's Doctor _________________________________ Phone ____________________

Address ________________________________________________________________

Child's Allergies __________________________________________________________

Current prescribed medication: _______________________________________________________________________

Child's special needs and conditions___________________________________________

In the event of an emergency involving my child, and if Voices of Faith Ministries cannot get in touch with me, I hereby authorize any needed emergency medical care. I further agree to be fully responsible for all medical expenses incurred for the treatment of my child.

Child's Name_____________________________________________________________

Signature (Parent/Guardian) ________________________________________________

Witness By ____________________________________Date _____________________

VOICES OF FAITHSUMMER CAMP

PHOTO RELEASE

Voices of Faith Summer Camp would like your permission to photograph/video your child for advertisement of our facilities. The photograph/video will be used for this purpose only. All rights to said photograph/video will remain the property of Voices of Faith Ministries.

Child’s Name

Parent’s Signature and Date

Director’s Signature and Date

Summer Camp Vacation/Leave of Absence Notification Form

Today’s Date: ____________________________________________________________

Name of Child(ren)________________________________________________________

________________________________________________________

Please select the dates your child(ren) will be on vacation.

Monday Tuesday Wednesday Thursday Friday Official UseWeek 1 5/30 □ 5/31 □ 6/1 □ 6/2 □Week 2 6/5 □ 6/6 □ 6/7 □ 6/8 □ 6/9 □Week 3 6/12 □ 6/13 □ 6/14 □ 6/15 □ 6/16 □Week 4 6/19 □ 6/20 □ 6/21 □ 6/22 □ 6/23 □Week 5 6/26 □ 6/27 □ 6/28 □ 6/29 □ 6/30 □Week 6 7/5 □ 7/6 □ 7/7 □Week 7 7/10 □ 7/11 □ 7/12 □ 7/13 □ 7/14 □Week 8 7/17 □ 7/18 □ 7/19 □ 7/20 □ 7/21 □Week 9 7/24 □ 7/25 □ 7/26 □ 7/27 □ 7/28 □

*A one week written notice must be given to Camp Voices before going on vacation, leave of absence, or withdrawing your child. I understand that if no written notice is given to Camp Voices as requested, a $25.00 charge will be added to your account.

Date vacation request was received:__________________________________________

________________________________________________________________________Signature (Parent/Guardian)