Summer Camp Registration Form 2015

Child’s Name :______Child’s Date of Birth/Age:______/____/_____ Does your child currently attend the POP After School Program? Yes____ No_____ ($20 discount for currently enrolled) Please indicate if your child will attend full time ___ (M-F 7:30am-6pm. $150/week) or Part-time ____ (M-F, 9am-1pm $95/week, daily $35 (does not include field trip fee)

Please check all weeks attending summer Camp and indicate full time or part time: __ June 15-19 Summer Kick Off __ July 20-24 Weird & Wacky __ June 22-26 All Stars Sports __ July 27-31 All About the Sea __ June 29-July 3 Let’s Get Fit __ Aug. 3-7 Space is the Place __ July 6-10 Animal Planet __ Aug. 10-14 Mix It Up __ July 13-17 Art Frenzy __ Aug. 17-21 Summers End Please read the following carefully and initial each statement: ___I give authorization for POP to administer basic first aid and to obtain medical care if needed and if we are unable reach any emergency contacts. ___I give authorization for my child to participate in field trips and swimming scheduled by POP. ___I understand that POP sets limits for campers designed for their own safety as well as the safety of others. POP does not permit aggressive or destructive behavior or the use of foul language. ___I understand that it is my responsibility to review the plans for each week of summer camp and be aware of what my child is participating in and what they will need to participate in certain activities or field trips. ___I understand that there is $25 deposit due upon registering for weeks of summer camp and payment in full for that week is due on the Monday of the week that my child is participating in. All payments received later than Monday will have a $20 late charge added to the account. If there is no payment for camp by Tuesday pickup of that week, the child will not be permitted to attend camp for the remainder of the week. ___ I understand that there will be no refunds for deposits due to illnesses or absences for any reason. If your child cannot attend the week that you have signed up for, POP will make every effort to add you to another week but cannot guarantee availability. ___I understand that deposits for summer camp are non-transferable to other goods and services including, but not limited to after school, general admission, or Parent’s Night Out. ___If your child does not have a POP t-shirt on the day of a field trip you will be required to purchase another one for $10. This is for the safety of our group when we are traveling.

I have read and accept all of the above policies. Signature/Date______

Summer Camp Registration Fee-$25 general public (covers POP T-shirt required to be worn on field trips)

Total Amount Paid:______Date of Payment______POP t-shirt received______