2006 Camp Extended Day Summer Program Julian Harris Elementary Child's Name _________________________Part-Time or Full-Time Street Address __________________________________________ Birthdate ______________________________________________ Grade Completed_________________School_________________ Parent/Guardian_________________________________________ Father's Employment___________________Phone_____________ Mother's Employment __________________Phone_____________ Family Cell Phone Numbers _______________________________ ______________________________________________________ Doctor's Name_______________________Phone_______________ Hospital of Choice _______________________________________ Days Camp Care is Required (Circle all that apply) M T W TH F Approximate Pick-Up Time ________________________________ Names of Siblings _______________________________________ ______________________________________________________ Persons, other than parents, allowed to pick up child(ren) :________ ______________________________________________________ Emergency Contact Names and Phone Numbers: _______________ ______________________________________________________ Known Medical Conditions: _______________________________ ______________________________________________________ Special Information/Comments: _____________________________ ______________________________________________________ ______________________________________________________ T-Shirt Size __________________________________________ Make Checks Payable to Decatur City Schools |
Camp Extended Day Guidelines I have read the Camp Extended Day Guidelines and I agree to the payment schedule and procedures outlined. I agree to keep my child(ren) home if they are ill and will be expected to pick my child(ren) up if they become ill. My child(ren) will not be sent back to Camp extended Day until they are well enough to participate in field trips and enrichment activities. I have attached a $20.00 registration fee, $40.00 field trip fee, and $15.00/$7.00 for insurance or a copy of verification of insurance per child.* Payments are made only for days attended. To assist in planning a quality program for your child(ren) please indicate below your scheduled vacation days. _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ *Registration fee, field trip fee, and insurance payment or proof of insurance is needed prior to the first day of attendance. A copy of coverage is needed for our records. ______________________________________________________ Parent/Guardian Date
Thank you for entrusting your child(ren) to our program . |