KBCC DAY SCHOOL

ADVENTUROUS SPLISH SPLASH SUMMER FUN & SWIM CAMP

355 Glenridge Road

Key Biscayne, Fl 33149

(305) 361-7501 Fax (305) 361-9556

License # C11MD0522

2016 CAMP REGISTRATION FORM

Registration Date ______Child’s Age______

Month Day Year

Child’s First Name ______Last Name ______

Nick name______Age _____ Sex M or F Date of Birth ______

Month Day Year

Address ______City ______

e-mail ______Home Telephone ______

Mother’s Name ______Cell ______

Father’s Name ______Cell ______

Please choose a Pass-code or Pin number for your child. Should you send someone unfamiliar to camp to

pick up your child, this person must have the Pass-code or Pin number in order for us to release your child.

Pass Code or Pin Number ______

Name of Insurance Company ______

Policy Number ______

Allergies and other Medical Information ______

Person to be called in case of an emergency in the event the parents cannot be reached:

______Phone ______

______Phone ______

In case of an emergency, we will attempt to contact the parents or emergency numbers listed. If these parties

are unavailable, I authorize KBCC to call Emergency Services to have emergency treatment performed,

and if necessary transport my child by ambulance at my expense.

A $50.00 non-refundable deposit must be paid for EACH session and balance must be paid the week before

they begin. If the payment is not received the week before, your child may be refused admittance to program.

There are no camp refunds for days your child is absent for any reason, including but not limited to illness,

vacations or holidays.

In the event I am unable to be reached, or fail to report the first day of camp, my child’s enrollment can be

denied and my fees shall not be refunded. By signing below, I accept the terms of this agreement.

Parent or Guardian Signature ______Date ______

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For Office Use Only

Session
Registered / Mon – Fri
Dates / Fee Per
Session / Deposit
Received / Balance
Due / Check #
Cash/CC
1 / May 31 – June 3 / $180
2 / June 6 – June 10 / $220
3 / June 13 – June 17 / $220
4 / June 20 – June 24 / $220
5 / June 27 – July 1 / $220
6 / July 4 – July 8 / $180
7 / July 11 – July 15 / $220
8 / July 18 – July 22 / $220
9 / July 25 – July 29 / $220
10 / Aug 1 – Aug 5 / $220

**Weekly balance due at Camp on Monday Morning of each week registered for. Any camper not paid in full for the week on MONDAY MORNING will not be admitted to camp. Bounce Houses, PE & Camp Swimming Lessons w/Alvaro, Gymnastics w/Oscar, Arts & Crafts, Music, Snack and Lunch, are all included in the fee. Please note, deposits are not refundable or transferable; deposits are only credited toward the week

registered for. In addition, we do not pro-rate for any days missed during camp. Thank you!

$220.00 per Session

Monday – Friday 8:00 – 3:00pm

Total Collected ______

Check # ______

After Camp Swim Lessons 3:00 – 3:45 Monday, Wednesday $15 each lesson ______

After Camp Soccer and Water Play (Boys and Girls) 3:00 – 3:45 $15 each lesson ______

Summer Camp Permissions

Child’s Name ______

The following are included in our summer program and require parental approval:

Sunscreen

I will apply each morning before sending my child to camp. Yet, the KBCC Summer Camp Staff is allowed to apply sunscreen that I have provided, to my child as needed.

______

Parent/Guardian Signature Date

Water Play

I will send my child to camp in a bathing suit and bring a towel and change of clothes. My child is allowed to partake in sprinkler, pool and water games at the KBCC Summer Camp.

______

Parent/Guardian Signature Date

Village Green and/or Library

I give my permission for my child to walk to the Village Green Park and KB Library for activities supervised by the KBCC Summer Camp Staff.

______

Parent/Guardian Signature Date