God S Garden Summer Camp

GOD’S GARDEN MINI-CAMP & SUMMER CAMP 2012 6035 Ridge Avenue * Philadelphia, PA 19128 * 215-482-4001

REGISTRATION FORM

Child’s Full Name ______Nickname ______Sex ______

Date of Birth ______School and Last Grade Completed ______

Home Address ______Zip ______Phone # ______

Father’s Name ______Mother’s Name ______

Father’s Work # ______Mother’s Work # ______

SPACE IS LIMITED: TO HOLD A SPOT FOR YOUR CHILD IN GOD’S GARDEN, PLEASE RETURN THIS FORM AND THE CAMP REGISTRATION FEE OF $30.00* PROMPTLY.

Please “Circle” the program fee you are choosing for your child – then check the appropriate week(s) your child will be attending.

8:30am- 8:30am - 12:00noon 5:30pm Weekly Sessions of Camp Morning Full Day God’s Garden will be closed Monday, May 28th Circle desired program/rate Session Session for Memorial Day Mini Camp:

5 Days ______June 4th ______June 18th Monday - Friday $79.00 $120.00 ______June 11th ______June 25th 3 Days Circle Days: Monday, Tuesday, $58.00 $84.00 Summer Camp: Closed July 2nd - 6th Wednesday, Thursday, Friday ______July 9th ______Aug. 6th 2 Days Circle Days: Monday, Tuesday, $47.00 $68.00 ______July 16th ______Aug.13th Wednesday, Thursday, Friday ______July 23rd ______Aug.20th Please note that the cost for mini-camp for current students will remain the same as your monthly tuition. ______July 30th

You will receive one (1) invoice for summer camp. This invoice will reflect the weeks you have chosen for your child to attend. We ask that you choose carefully. All camp fees must be paid in advance. Any weeks that you have chosen and paid for, but did not attend will not be refunded nor credited. Your camp invoice must be paid in full if your child will attend 4 or fewer weeks throughout the summer. This payment is due by Monday, July 9, 2012. Children attending 5-8 weeks of camp throughout the summer may split their invoice into 2 equal payments. The first payment is due by Monday, July 9, 2012 and the second payment is due by Monday, July 30, 2012. *God's Garden offers extended times for early care as well as aftercare. Early Bird Hours available 7:30am-8:30am - $2.00/half hour Night Owl Hours available 5:30am-6pm - $2.00/half hour Child’s Name ______Page 2 of Summer Camp Registration

Required Paperwork

I, ______the parent/legal guardian of ______, understand that my child will not be admitted to camp on the first day without all the necessary paperwork which includes the registration form and a current Health Assessment Form.

Photo Release I, ______the parent/legal guardian of ______, give permission for my child’s photo to be taken. I also understand that the photo may be displayed in camp, shown in a slide show to the church, used on our web site or sent to the local paper.

The undersigned parents/guardian of ______(Child’s name) in consideration and as a part of the undertaking of the parties, hereby agree not to make any claim on behalf of the Child or on their own behalf against God’s Garden or the Roxborough Baptist Church, or any of their agents or employees, for any personal injuries sustained by such Child while engaged in Summer Camp activities on or away from the premises of the church and the undersigned agree to indemnify and hold harmless the Summer Camp and the Church, their agents or employees, on account of any liability which may be imposed upon them or any of them as a result of any such personal injuries.

Dated: ______Parent or Guardian’s Signature ______

We were referred to God’s Garden by: ______