Train up a child in the way he should go, and when he is old he will not turn from it. Proverbs 22:6

Transcription

1 Union Grove Summer Camp Union Grove Missionary Baptist Church 809 S. Davis Drive, Warner Robins, GA Phone: David A. Clarke, Sr., Senior Pastor Teddy Madison, Assistant Pastor Elder Rashee Ragin, Youth Vision Leader Michelle Clarke, Camp Director Dear Parent/Guardian: Train up a child in the way he should go, and when he is old he will not turn from it. Proverbs 22:6 Thank you for your interest in our 2017 Union Grove Summer Camp. Camp will be held Tuesday, May 29, 2018 Friday, July 20, Attached you will find the application for your completion. It is very important that you read each page and fill out all the necessary information. The registration forms and application fee ($50) are due at the time of registration. Application Checklist: Part 1: General Information Part 2: Parent Commitment Form for Summer Camp Part 3: Field Trip Permission Part 4: Fees and Attendance Applications can be mailed or dropped off at the Union Grove Missionary Baptist Church main office. If you have any uestions, please feel free to call (478) or contact the camp via at ugmbcsummercamp@hotmail.com. Sincerely, Union Grove Summer Camp Staff

2 Member Union Grove Summer Camp REGISTRATION FORM Non-member Part 1: General Information/ Program Involvement CAMPER PROFILE Last Name First Name M.I. Gender School Name D.O.B: o Male o Female / / Street Address City: State: Zip Code: Age on Last Birthday: yrs. Grade in Spring 2017: T-Shirt Size FAMILY PROFILE Parent / First Name M.I. Last Name Relationship to Youth: Guardian 1 Street Address Zip Code Home Phone Work Phone Cellular Phone Parent / Guardian 2 First Name M.I. Last Name Relationship to Youth: Street Address Zip Code Home Phone Work Phone Cellular Phone What do you hope your child(ren) will gain from their participation in the Union Grove Summer Camp? Union Grove Missionary Baptist Church Page 2

3 EMERGENCY INFORMATION Emergency Contact First Name Last Name (MUST BE DIFFERENT FROM PARENT / GUARDIAN LISTED) Daytime Phone Cellular Phone Relationship to Youth Health Insurance ne Carrier Identification Number Health Insurance Phone# Group Number Authorization (Parent Guardian 1) I hereby authorize the Union Grove Summer Camp employees, agents, and youth workers to transport my child to a medical facility in case of an emergency. Signature of Authorization MEDICAL HISTORY Is the youth currently taking medication? o Yes If yes, please explain: Does the youth have any behavior issues that may be of concern? o Yes If yes, please explain: Are there any factor(s) that would prevent the youth from full participation in daily activities? o Yes If yes, please explain: Check, giving approximate dates. Write N/A for all that does not apply. DO NOT LEAVE BLANK. Allergies Diseases Ear Infections Hay Fever Chicken Pox Rheumatic Fever Ivy Poisoning etc. Measles Convulsion Insect Stings German Measles Diabetes Penicillin Mumps Behavior Other Drugs Asthma Name Past Illnesses Contagious Illnesses Operations or Serious Injuries (s) Hospitalization (s) Chronic or Recurring Illness To be restricted? Physician s Name Physician s Phone Number Union Grove Missionary Baptist Church Page 3

4 SUMMER CAMP: PARENT COMMITMENT PART 2 I agree that during the time my child(ren) is enrolled in the Union Grove Summer Camp, I will try to: Participate in any called parent meetings; Do my part to help make the camp a caring and nurturing learning environment; Ensure that my child(ren) is in attendance daily. SUMMER CAMP: PROGRAM INVOLVEMENT INFORMATION Camp : Tuesday, May 29, 2018 Friday, July 20, 2018 Camp Schedule: 7:30am 5:30pm (includes breakfast, snack and lunch) Camp Field Trips: Fridays SUMMER CAMP: YOUTH RELEASE INFORMATION The following persons have permission to pick up my child/children from camp: Pickup 1 Name Phone Number Relationship to Youth Pickup 2 Name Phone Number Relationship to Youth Pickup 3 Name Phone Number Relationship to Youth Additional Youth Release Information / Comments: Union Grove Missionary Baptist Church Page 4

5 PART 3 FIELD TRIP PERMISSION Trips are scheduled to enhance youth academically, improve their social skills and further their awareness of the area s cultural amenities. Please complete the information below and return it to camp staff as soon as possible. I,, have enrolled my child,, in the Union Grove Summer Camp. I hereby give consent for my child to partake in the following activities that may take place during the program s regular daily hours: Take supervised walks Go to nearby playgrounds Take afternoon trips to nearby areas such as bowling, skating, etc. Eat meals/snacks purchased by the program or group leader I also give permission that, in the event of an emergency, injury or illness, staff members in charge of the trip may authorize and obtain medical treatment for my child. PART 4 FEES AND ATTENDANCE FORM Due at Registration: $50 Application Fee (Includes Camp T-Shirt) *NON-MEMBERS - $75 Weekly Day Camp Fees (per youth); $70 for second child; $65 for third child *MEMBERS - $60 Weekly Day Camp Fees (per youth); $55 for second child; $50 for third child I understand that payments for any fees will be taken by cash, check or money order (payable to Union Grove Missionary Baptist Church) I understand that cancellations for any week, for any reason, within 7 days of the program week are not refundable nor transferable under any circumstances. I understand that the Camp fees are due the week (Monday) before the week of attendance. I understand that the Camp fees include breakfast, snack and lunch. I understand that no refunds are given if a child leaves early for any reason. I have read, I understand, and I agree to abide by these policies. Union Grove Missionary Baptist Church Page 5