Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address:

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Mervyn Cobb
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1 ZION CHRISTIAN CHILDREN S CENTER SCHOOL AGE SUMMER CAMP Zion United Methodist Church ~ 1674 Zion Road Troy, VA (434) ~ ZionUMCAfterschool@gmail.com Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address: Marital Status of Parents: Married Single Divorced Separated Deceased Child lives with: Mother Father Other: Mothers Name: Mother s Occupation: Mother s Business Address: Work Phone: Cell Phone: Father s Name: Father s Occupation: Father s Business Address: Work Phone: Cell Phone: List any information we may need to know about your child. (medication, allergies, food

Divorced Separated Deceased Child lives with: Mother Father Other: Mothers Name: Mother s Occupation: Mother s Business Address: Work Phone: Cell Phone: Email: Father

2 restrictions, developmental concerns): Emergency Situations/Alternate Pick-Up: In case of emergency or sudden illness the parents are the first to be contacted. In the instance that we are unable to reach the parents, we ask that you please list the names of local people that would assume responsibility for your child. Picture identification will be required for student release. If someone other than the listed persons is to pick-up your child you must send a written note. Name: Relation: Phone #1: Phone #2: Name: Relation: Phone #1: Phone #2: Name: Relation: Phone #1: Phone #2: Medical Release: I grant the staff to Zion Christian Children s Center and Zion United Methodist Church permission to seek medical treatment for my child in case of emergency. Physicians Name: Phone: Parent Signature: Date: Photography/Video Release: I grant permission for Zion Christian Children s Center to take video or photograph recordings of my child. I understand that they may be used for promotion, marketing, advertising or training purposes. The video/photograph footage will not violate the rights of any organization or person. I release Zion Christian Children s Center and Zion United Methodist Church from any and all present and future claims for compensation. Parent Signature: Date: ZION CHRISTIAN CHILDREN S CENTER SCHOOL AGE SUMMER CAMP TUITION (2012)

Picture identification will be required for student release. If someone other than the listed persons is to pick-up your child you must send a written note.

3 Zion United Methodist Church ~ 1674 Zion Road Troy, VA (434) ~ ZionUMCAfterschool@gmail.com Tuition for attendance in the Summer Camp at Zion Christian Children s Center is as follows. Please check the appropriate program your child will be attending: School Age Group (Rising Kindergarten-6 th Grade)$100/per week $75/per week when enrolling additional school age siblings Please select all the days your child will be attending on a regular basis: Monday Tuesday Wednesday Thursday Friday Please select a payment option that best suits you: Weekly Bi-Monthly Monthly Children that are scheduled to attend the program and are not present due to illness or vacation, etc. are still expected to pay for the week of absence. Payments must be made the previous weeks of care. You will receive a payment reminder via and attached to your child sign out form. If the payment is not paid by the date specified you will be notified and your child must be picked up immediately and can not return until the payment is made. There will be no refunds on tuition paid. Checks should be made payable to Zion UMC Summer Camp and should be given by an adult to the After School Director or Summer Camp Counselor. Tuition money will not be accepted from children. Receipts can also be given upon request. Children should be picked up no later than 6pm each day. Parents that arrive after 6:10pm will be charged a fee of $1/minute until the child is picked up. By signing below you agree to all of the above. Parent Printed Name Parent/Guardian Signature Date ZCCC Summer Camp Policy

select all the days your child will be attending on a regular basis: Monday Tuesday Wednesday Thursday Friday Please select a payment option that best suits you: Weekly Bi-Monthly Monthly Children

4 Communicable Diseases Policy: 1. If it is observed that a child is ill, or becomes ill or injured in our care, we will separate him/her from the other children and notify parents/guardians immediately. The child must be picked up within one hour of our call. 2. He/she may NOT return until 24 hours after the temperature returns to normal. We may require a doctor s release note in order for your child to return to the program at our discretion. 3. The parent or guardian agrees to notify ZCCC staff within 24 hours or the next business day after their child, or any many member of their household, has developed a reportable communicable disease. Life threatening diseases must be reported immediately. 4. Tuition will still be collected for absences due to illness. Transportation Policy: Zion Christian Children s Centers Summer Camp, a ministry of Zion United Methodist Church, may be transporting children to and from field trips throughout the summer. During transporting, all drivers will hold a valid drivers license and all vehicles will be insured and registered. Parents/Guardians will always be notified of field trip dates and will be required to sign a permission slip. While being transported, ZCCC and all of its affiliates, including drivers and counselors, will take precautions before, during and after transporting and will not be held responsible in the case of an accident or emergency. In the case of an accident, if deemed necessary by the EMS officials, the specified child/ren will be transported to the nearest hospital to be examined, in which, parents/guardians will be notified at this time. Possession Policy: The children in the ZUMC Summer Camp are allowed to bring electronic devices (GameBoy, DS, Ipad etc) to Camp for personal use during Drop Off and Cool Down times only and must not share or distribute any of their games to another camper. In the case that this does occur I will not hold ZUMC or any of its counselors responsible for loss. If a child refuses to abide by these rules their privilege to use electronics at Camp will be revoked and they can no longer bring their devices. Parent Statement of Understanding By signing below I acknowledge that I have read and agreed to the following: 1. I understand the aforementioned policies and tuition agreement and agree that myself and my child will follow these guidelines. 2. I recognize that the staff of Zion Christian Children s Center will do their best to ensure a safe experience. I understand that accidents may occur from my child s participation in activities. I agree to assume these risks. I release Zion Christian Children s Center, it s staff and volunteers, from all liability based on any damage, loss or injury. Child s Name Date Parent/Guardian Signature ZCCC SCHOOL AGE SUMMER CAMP WEEKLY THEMES *Please select which weeks your child will be attending*

The child must be picked up within one hour of our call. 2. He/she may NOT return until 24 hours after the temperature returns to normal.

5 Week 1: May 14 th -18 th Week 2: May 21 st -25 th *Welcome to Camp! *Baby Animals Week 3: May 28 th -June 1 st Week 4: June 4 th -8 th *All Grown Up *Dandy-Lions and Busy Bees Week 5: June 11 th -15 th Week 6: June 18 th -22 nd *All around the Garden *Giddy Up and Go Week 7: June 25 th -29 th Week 8: July 2 nd -6 th * Sports, Sports, Sports! *God Bless America Week 9: July 9 th -13 th 10: July 16 th -20 th *Bon Appetite! *Olympics Week 11: July 23 rd -27 th 30 th -Aug 3 rd *Going Overboard! (VBS Themed) Week Week 12: July *Holidays Week 13: August 6 th -10 th Week 14: August 13 th -17 th * All Grown Up *The Sky s the Limit Week 15: August 20 th -24 th 27 th -31 st *Playground Palooza Lookout Week 16: August *Cookout

Garden *Giddy Up and Go Week 7: June 25 th -29 th Week 8: July 2 nd -6 th * Sports, Sports, Sports! *God Bless America Week 9: July 9 th -13 th 10: July 16 th -20 th *Bon Appetite!

6 *Please be aware that weekly themes and daily activities are subject to change at the discretion of the Director.* ZCCC Summer Camp T-Shirts *All children will receive a ZCCC T-shirt to wear during field trips and to take home at the end of the summer! Please choose the correct size needed* Youth: XS(4) S(6-8) M(10-12) L(14-16) XL(18-20) Adult: S M L XL 2XL SCHOOL AGE CAMP DAILY SCHEDULE 7:00-9:00: Drop Off (Breakfast is given if provided and morning free play in their homeroom) 9:00-10:00: Free Play 10:00-10:30: Snack 10:30-12:00: Recess (Chapel will also be held on Wednesdays during this time.) 12:00-1:00: Lunch 1:00-3:30: Themed Fun Play (This is when the children will be doing their planned activities, field trips and meet our special visitors! Chapel will also be held on Wednesdays during this time.) 3:30-4:00: Snack 4:00-6:00: Cool Down (The children are able to relax after their exciting day with free play, a movie, board games and coloring sheets.) *Please be aware that the children will be relocating all throughout

Please choose the correct size needed* Youth: XS(4) S(6-8) M(10-12) L(14-16) XL(18-20) Adult: S M L XL 2XL SCHOOL AGE CAMP DAILY SCHEDULE 7:00-9:00: Drop Off (Breakfast is given if provided and

7 the day and will only be in their homerooms during Drop Off and Cool Down*

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl REGISTRATION FORMS Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Address: City: State: Zip Code: Child #1 Days of the