Bendle Community Education Tiger Kid's Club Summer Camp Adventure

Transcription

1 Bendle Community Education Tiger Kid's Club Summer Camp Adventure 2016 Summer Registration Form Sponsored by: Bendle Community Education Today's Date: 1. Child's Name Shirt Size Age Sex Address City Zip Birthdate School district attending ( ) Grade Describe any special dietary needs, medical problems, allergies, etc., we need to be aware of: 2. Child's Name Shirt Size Age Sex Address City Zip Birthdate School district attending ( ) Grade Describe any special dietary needs, medical problems, allergies, etc., we need to be aware of: CHILD(ren) LIVES FULL TIME WITH: Both Parents Mother Father Other Weekly Program Costs $59 per week for 1 child $89 per week for 2 children $129 per week for 3 children $169 per week for 4 children $209 per week for 5 children To receive the multiple children discount above, children must be related by blood or officially adopted by same parent(s) and living in the same home. You may be asked to provide necessary proof. Daily Program Costs $20 per day per child 1

2 Parents and/or Guardians responsible for child(ren): 1. Mother's full name Address City Zip Home phone Work phone Cell phone Name of employer Work hours Employer address Employer phone 2. Father's full name Address City Zip Home phone Work phone Cell phone Name of employer Work hours Employer address Employer phone Persons other than parent(s) to notify in case of emergency when parent(s) cannot be reached? 1. Name Address City Zip Home phone Work phone Cell phone 2. Name Address City Zip Home phone Work phone Cell phone Besides those above who else is authorized to pick up child(ren)? 1. Name Relationship 2. Name Relationship 3. Name Relationship 4. Name Relationship Bendle Public Schools Tiger Kid's Club Latch Key is licensed through the State of Michigan Department of Human Services, Lansing, Michigan, License #DC

3 Emergency Information: Child's physician and/or health clinic name Office hours Phone number Address City Zip Hospital preferred for emergency treatment Health insurance name Health insurance number(s) Medical Verification: I, certify that my (Parent's Name) child(ren), (Child or Children Name) is/are in good health and is/are able to participate in the Tiger Kid's Club Latch Key program without restrictions. I also certify that all my child's immunizations are up-to-date. Parent Signature Date I certify that by completing and signing this form that it is with full knowledge and consent that my child may participate in all of the Bendle Public Schools Tiger Kid's Club Summer Program. I understand and grant permission for my child(ren) to use all of the equipment including the playground which may or may not comply with guidelines in the 1997 handbook for Public Playground Safty. I hereby grant permission to Bendle Public Schools Tiger Kid's Club program, licensed by the State of Michigan Department of Human Services, to secure emergency medical and/or emergency surgical treatment for the above named minor child(ren) while in care. I, also, hereby grant permission for my child(ren) to be included in pictures connected with the Tiger Kid's Club program. I hereby claim that all information given here is true and all policies are understood in regard to the Tiger Kid's Club Summer program and that if any personal information changes, that it is my responsibility to communicate that to the program. Parent Signature Date Office Use Only: Amount Paid $ Method: Date: Staff Initials: 3

4 Child(ren) Name(s) Please fill in estimated arrival and departing times for the weeks your child(ren) will be attending. For us to plan for staffing, we ask that you be as specific as possible when choosing your schedule. Everyone will be responsible for paying for their chosen schedule even if child(ren) do not attend, however, one week will be allowed during the program as a grace period without penalty (1 weeks notice required). A family will be able to add days/weeks but only with a 48 hour notice prior to attendance and based on availability. We appreciate your assistance with this as it is difficult to plan appropriately without it. Only full time students are allowed to attend field trips. Week 1 June 20-24: Week 2 June 27-July 1: Week 3 July 4-8: CLOSED Week 4 July 11-15: Week 5 July 18-22: Week 6 July 25-28: Week 7 August 1-5: Week 8 August 8-12: Week 9 August 15-19: Week 10 August 22-26: Parent Signature: Date (Your signature indicates you understand all of the policies connected to the Tiger Kid's Club Summer Camp Adventure and will pay for those days/weeks you select for your child(ren) to attend.) 4

5 Bendle's Community Education Tiger Kid's Club Summer Camp Adventure (keep this page for your reference throughout the program) Kindergarten through 5th grades (Incoming Kindergarten through incoming 5th grade for school year) West Bendle Elementary, 4020 Cerdan, Burton, MI (Near Bristol & S. Saginaw) Summer fun activities that keep students active and enjoying their day to day schedule away from home! Field trips are planned during July and August months. (FREE breakfast, lunch and afternoon snack provided) When: June 20-August 26, 2016 (Closed July 4-8) Days: Rates: Register: Payments: Monday-Friday--6:30 AM to 6:00 PM $59 per week for 1 child $89 per week for 2 children $129 per week for 3 children $169 per week for 4 children $209 per week for 5 children Daily--$20 per child per day (Field trip costs are additional-no Refunds due to illness, inclement weather, etc. If trip is canceled, field trip money will be used that day or for future special activities). Must pre-register with Community Education Office (2294 E. Bristol Rd. or call ) or at Tiger Kid's Club (West Bendle). All paper work must be filled out and 1st weeks tuition paid for before registration will be accepted. Register by Monday, June 1st to avoid $20 registration fee. Payment is due every Friday by 6:00 pm as a pre-payment for the upcoming week. Any payment after this will be considered late and a $15 late fee is charged. NO EXCEPTIONS! All returned checks will be assessed a $15 charge. We do not accept out of district DHS families. Things You Should Know: Do Not Return this page! It is for your information to keep and refer back to during the program. Bags/Backpacks--Please have your child(ren) use a backpack or bag to carry in and out their belongings from the program. It's an all day adventure, so there may be lots of items for your child to keep track of and a backpack or bag will greatly assist them. Field Trips--Only full time students are allowed to attend field trips. Lunches from Home--No lunches brought from home will be heated--cold lunches only please. Also, we ask that no pop or caffine drinks be brought in. We prefer that anything brought from home be healthy and appropriate in size. Toys--We ask that absolutely no toys from home be brought to the site. (This includes electronic devices.) Wii games must be approved by a staff member. Label--Put names on all articles/items. Things get lost or misplaced and this will help all of us to identify your child(ren) possessions. Water Bottle--Please provide a water bottle for everyday use. They may be left at the site (put names on them) and we will fill and wash them daily. Late Payment Fee--All payments are due on Friday by 6:00 PM. Any payment made after this time will require an additional $15 as a late fee. Please help us out with our staff's schedule and be on time with payments. Late Pick Up Fee--Picking up child(ren) after 6:00 PM will incur a charged of $1 per minute. Referral Discount--Refer a new family to our summer program and get 20% discount on 1 week. Water Days--Summer can be very warm so we offer water fun for these days. Please bring an extra set of dry clothes or swim suit AND towel. (These can be brought each day or left onsite.) No 2 piece suits for girls are allowed. If this is all that they have, then a longer tshirt must be worn over the suit. Medications/Sunscreen-If your child needs any medications (prescription or nonprescription) or sunscreen administered, you must fill out a medication form before this can be done during program hours. Spray on sunscreen will be the only sunscreen adminstered by staff. Payment Types--We accept Cash, Checks, Visa, MasterCard and American Express. Onsite Phone Number