Got Camp?
Remember those days of Summer Camp as a child? Fun-filled days with friends, swimming, crafts, food, games, field trips. We will be creating an atmosphere for kids to have fun, relax and learn God’s word. “Train up a child in the way he should go and when he is old he will not depart from it” Proverbs 22:6
Director: Sabrina Forney
Counselors: Sandra Justiniano, Ana Zamora, Tammy Martin, Eryne Kenney,
Rick Forney, Shannon Boone
Kitchen Manager: Donna Thibideaux
Grounds keeper: Mike Rhoden
email:
Website: westsidecc.org
Phone: 407-398-9509
Fax: 407-880-7244
1937 Lakeville Rd.
Apopka, FL 32703
DCF License # C09OR0645
Westside Community Church Summer Camp Enrollment Form 2015
Date ______T-shirt Size ______
Student Name ______
Last First Middle Initial
Birth date _____/_____/_____ Gender: M F Preferred name______
Street Address: ______
City ______State______Zip______
Home Phone: ______Day time phone: ______
Email Address: ______
Guardian Information:
Dad’s name: ______
Employer: ______
Work phone: ______Cell phone: ______
Mom’s name: ______
Employer: ______
Work phone: ______Cell phone: ______
Emergency contact / authorized pick up: ______
______
Medical Information and Release: I hereby grant permission for the staff of Westside Community Church Summer Camp to contact the following medical personnel to obtain emergency care if warranted.
Family Physician: ______Phone: ______
Family Dentist: ______Phone: ______
Hospital preference: ______
Please list all food allergies, medical allergies, special medical needs or conditions:
______
______
______
______
What school does your child attend? ______
Do you have current physical and shot records on file there? q Yes q No
Westside Community Church
Summer Camp Enrollment Agreement
Acceptance of this enrollment agreement, along with the $25 non-refundable registration fee must be paid at the time of registration to assure your child a spot in the Summer Camp.
WCC expects all families to honor their enrollment agreement for the entire term, throughout the summer. Emergencies that require a student to withdraw will be dealt with it on a case-by-case basis.
This form contains a Terms of Agreement as an additional sheet, and forms a binding contract once signed.
Late fees in the amount of $10.00 are assessed on Tuesdays for any balance on your account. Continued late payments can result with loss of space at WCC Summer Camp.
Who is responsible for payment of Tuition/Fees? ______
______
Signature Parent/Guardian Date
______
Signature Parent/Guardian Date
Tuition/Fees/Charges
Full Day (7:00am-6:00pm) Weekly rate: $125.00 (per child)
Half Day (7:00am-12:30pm) of (12:00p-6:00p) Weekly rate: $75
Summer Camp Dates: June 8th - August 14th, 2015 (7:00am to 6:00pm)
· Tuition is due in full every Monday for that week.
· There will be a $10.00 late fee if tuition is not received by Tuesday of every week. Your child will not be able to return to camp until all payments are made.
· Late pick up fee charges: There will be a late pick up fee of $1.00 per minute if you are late picking your child up. Remember we close at 6:00pm
· Returned check fee: There will be a $25.00 charge for all returned checks. Cash or money order will be required for repeat offenders.
· Refunds: There is a no refund policy for tuition and registration fee.
· You may choose the weeks you require summer camp for; however, ALL weeks registered for will be billed, regardless of child’s attendance.
Westside Community Church Summer Camp Emergency Treatment Form
Please Note: This form needs to be signed in the presence of a notary, which we can provide if necessary
Camper’s name ______Birth date______
Guardian’s Name______
Home Phone ______Work Number ______
Cell Phone______
As the parent or guardian, I am aware of the involvement and participation of this minor in the activities and excursions of WCC Summer Camp. I authorize the staff and adult chaperones of WCC Summer Camp to exercise temporary custody and care of my child for Summer Camp related events.
In the event of illness or accident which requires immediate treatment at a time when the parent, the child’s physician, or other emergency contacts cannot be located, I hereby give permission for the staff of Westside Community Church Summer camp to obtain and provide such emergency treatment as may be deemed necessary.
· I AGREE to pay costs of any such care and treatment so obtained and provided and will not hold WCC or the Summer Camp liable for such costs.
· I WILL NOT hold the church, the Summer Camp, or the staff responsible for the results of such emergency care.
· I UNDERSTAND that this permission is only to be used in extreme emergencies and that all possible efforts will be made to contact me before medical treatment is sought for my child.
· I UNDERSTAND that it is solely my responsibility to provide updated medical forms. I also understand that these forms will be held on file and used for all events in which my child participates.
______
Signature Parent/Guardian Date
State of Florida, Orange County, before the undersigned authority, stated below personally appeared ______who has signed and agrees to the terms set forth in the above agreement.
Sworn and subscribed before me this
______day of______, 20_____
______(signature of notary)
I give permission for my child ______to go on all fieldtrips with the WCC Summer Camp. I understand they will be riding in private automobiles provided by the chaperones of WCC.
Medical Information Release:
I hereby grant permission for the staff of WCC Summer Camp to contact the following medical personnel to obtain emergency care if warranted.
Physician: ______Phone: ______
Family Dentist: ______Phone: ______
Hospital Preference ______
Please list all food allergies, medical allergies, special medical needs or conditions:
______
______
______
______
My emergency contact information:
Dad work: ______Dad cell: ______
Mom work: ______Mom cell: ______
______
Signature Parent/Guardian Date
State of Florida, Orange County, before the undersigned authority, state below personally appeared ______who has signed and agrees to the terms set forth in the above agreement.
Sworn and subscribed before me this
______Day of ______, 20___
______
(Signature of notary)
Pool Permission Form
I ______give my child, ______permission to go to the pool located on the Westside Community Church property at 1937 Lakeville Rd Apopka, FL. I understand there will be a Life Guard on duty at all times when the Summer Camp children are present.
q I understand that I need to apply sunscreen on my child before they arrive at camp each day.
q My child is an avid swimmer.
q My child is not a swimmer.
q My child is a beginner swimmer.
Swimmers Ear Drops Permission Form
I (do / do not) request and give permission to the staff at Westside Community Church to administer swimmer’s ear drops (a mixture of alcohol and water) in my child’s ears after swimming each day. (please circle one) ______
Movie Permission Form
I ______give my child, ______permission to watch movies. I understand that the students will be watching movies that are rated either G or PG.
Field Trip Transportation
I understand that all Field Trips will be transported by personnel staff and volunteers of Westside Community Church. I understand that all people will be screened and background checked and all safety precautions required by DCF pertaining to checking in and out will be observed.
______
Signature Parent/Guardian Date
WCC Summer Camp Weekly Schedule
Ages 5 - 8 Ages 9 - 12
700a – camp opens 700a – camp opens
7a – 745a – all centers open 7a – 745a – all centers open
745a – 800a – wash/bathroom for breakfast 745a – 800a – wash/bathroom for breakfast
800a – 830a – breakfast 800a – 830a – breakfast
830a – 845a – wash/bathroom 830a – 845a – wash/bathroom
845a – 905a – worship and Bible story 845a - 905a – worship and Bible story
905a – 920a – change for pool / sunscreen 905a - 10a - outdoor centers (football, Frisbee, softball, etc)
920a – 930a – walk to pool / review pool safety 10a – 1020a – change for pool / sunscreen
930a – 1030a – open swim (life guard on duty) 1020a – 1030a – walk to pool / review pool safety
1030a – 11a – change / wash / bathroom 1030a – 1130p – open swim (life guard on duty)
11a – 1130a – read / journal time 1130a – 12p – change / wash / bathroom
1130a – 12p – lunch 12p – 1230p – lunch
12p – 1215p – wash / bathroom 1230p – 1245p - wash / bathroom
1215p – 2pm – nap / rest (non-nappers) 1245p – 115p – reading / journal time
2pm – 215p – wake, wash / bathroom 115p – 145p – art / drawing
215 – 245pm – all centers open 145p – 245p – all centers open / game time
245p – 3p – snack 245p – 3p - snack
3p – 430p – specials or outdoor centers 3p – 430p – specials or outdoor centers
430 – 6p – all centers open (games avail for older kids) 430 – 6p – all centers open / games / craft
6p – dismissal 6p – dismissal
(Field Trip Days) (See Field Trip List for times of departing and arriving)
7a – 8a – all centers open
8a – 815a – wash/bathroom for breakfast
815a – 845a – breakfast
845a – 9a – wash/bathroom
9a – 920a – worship and Bible story
920a – load and depart
2p - arrive back from field trip
2p – 3p – rest / read (quiet time)
3p – 315p - snack
315p – 430p – specials or outdoor centers
430 – 6p – all centers open (games avail for older kids)
Please check the weeks that your child will be attending Summer Camp at Westside:
q June 8 - 12 Putting Edge*
q June 15 - 19 Orange Blossom Express*
q June 22 - 26 TBD*
q June 29 – July 3 Plaster Cottage*
q July 6 - 10 bowling*
q July 13 - 17 Monkey Joe’s*
q July 20 - 24 Orlando Science Center*
q July 27 – July 31 Orlando Shakespear Theater*
q August 3 - 7 Let’s Skate*
q August 10 - 14 Rebounderz*
I, ______, understand that by checking these weeks, I am asking Westside Community Church Summer Camp to reserve a spot on the above marked weeks for my child/children. I also understand that I am expected to pay for these weeks, regardless of my child/children’s attendance. If I do not pay, the spot reserved for my child/children can be forfeited and given to another child on the waiting list.
(Sign)______(date) ______
*subject to change upon availability of facility