Summer Day Camp

Child Information:

Full Name

Age

Gender

Grade (Entering Grade)

Parent Information

Full Name

This address will receive a confirmation email

Address

Phone

Emergency Contact (Not Same As Above)

Name

Phone

Cell Number

Medical Information

Does your child have health Insurance?

yes no

Insurance Carrier Name (Please Use NA if not available)

Insurance Policy Number(Please Use NA if not available)

Does your child have any allergies or food restrictions? If so, please list.

Payment Options

Spaces are very limited; please select the week or weeks that your child will attend and make a $30.00 deposit for each week chosen. Deposits will be applied to the weekly fee of $100.00. Remaining balance for each week is due the Friday before the coming week.

Week 2 (June 19-23)

Week 3 (June 26-30)

Week 4 (July 3-7)

Week 5 (July 10-14)

Week 6 (July 17-21)

Week 7 (July 24-28)

To pay for individual days, we ask that you purchase a minimum of 3 days up front. The days do not need to be used consecutively. Because space is limited, we may not be able to guarantee your child's space for a day without payment. Contact us with specific dates- camps@cbcsebastian.com

Whole camp paid in full with a 10% discount!

Liability Release

By selecting the box below I agree to the following statement:

I do hereby consent to authorize and direct chaperones of Community Baptist Church to obtain for my child such medical care, treatment, and hospitalization as may deem necessary. I do hereby release, remiss, and forever discharge the chaperones and Community Baptist Church for any and all claim, demands, actions or cause actions, past, present, and future, known or unknown, arising out of any injury to my child. I give permission to Community Baptist Church to take photographs and/or videos of my child which may be used for internal publication and/or associated social media.

Liabilty Release

I agree I have questions

RULES

My student agrees to abide by the rules set forth by camp staff in order to participate in summer day camp.

Yes, we agree We need more information

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Summer Day Camp

Description

Please Fix the Following