Registration Application for Holy Mackerel Kidz Summer Camp 2011
A $25 non-refundable deposit is due for each week you wish for your child to attend.
Please turn in with this application.
Immanuel Anglican Church, 250 Indian Bayou Trail, Destin, FL 32541
Tami Bonhardt-Carr, Director
(850) 837-6324 or 586-8264
Holy Mackerel Summer Camp=s curriculum teaches from a Christian perspective.+
This camp is for children who are entering grades kindergarten
through fifth for the fall of 2011-2012.
Please circle the session or sessions you wish your child to attend. Total cost for campers is $100 per session per child. $80 per child per session for additional siblings. Remember your child’s place IS NOT secure until we have received a $25 non refundable deposit for each week of attendance & current photo of your child. We encourage you to register early. The remaining $75 is due the first day of each session.
Session 3-June 27th-July 1st (this session we will be including Little Mackerels ages 3 and up)
Session 4-July 4th-July 8th (this session we will be including Little Mackerels ages 3 and up)
Session 5-July 18th - July 22nd
Session 6-July 25th-July 29th
Session 7-August 8th-12th NEW SESSION JUST OPEN
Child=s Information:
T-Shirt Size______Grade in Fall ______
Date of Birth:______Sex:______Date of Enrollment:______
Full Name:______
Last First Middle Nickname
Address:______
Contact Phone Number:______E Mail Address:______
Family Information: Child Lives With:______
Father=s Name:______Mother=s Name:______
Address:______Address:______
Home Phone:______Home Phone:______
Employer:______Employer:______
Cell Phone:______Cell Phone:______
Work Phone:______Work Phone:______
Brothers & Sisters at Home (Names & Ages):______
Church Affiliation:______If none, preference:______
Child=s Previous School Attendance:______
Medical Information:
I hereby grant permission for the staff of Holy Mackerel Summer Camp to contact the following medical personnel to obtain emergency medical care if warranted.
Doctor:______Address & Phone:______
Dentist:______Address & Phone:______
Hospital Preference:______Please list any allergies, special medical or
dietary needs:______
Contacts:
Children will be released only to the custodial parent or legal guardian & the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or other emergency, if the parent or guardian cannot be reached.
Name:______Two Phone Numbers______
Name:______Two Phone Numbers______
Name:______Two Phone Numbers______
Name:______Two Phone Numbers______
Holy Mackerel Summer Camp=s Disciplinary Practice:
First offense: verbal warning
Second offense: verbal warning
Third offense: Atime out@ area (aka Fish Out of Water Area)
Fourth offense: Parents will be notified
By signing below, you verify that you have received the above items and all information on this enrollment is complete and accurate.
______
Signature of Parent or Guardian Date
Please attach, with this form, your $25 check per child-per session, written to “Immanuel Anglican Church” and designate in the memo line ASummer Camp@ and a current photo of your child or email the photo to .
Each child is responsible to bring his/her own lunch and drink daily.
No Microwaveable foods. Please apply SUNSCREEN daily before brining your child to camp.
Please tell us how you heard about this camp______
Holy Mackerel Kidz Summer Camp is a non-discriminatory school that admits students of all races, color, national and ethnic origin to all the rights, privileges, programs and activities. We do not discriminate on the basis of race, color, or national and ethnic origin in administration of our educational policies, admission policies, scholarship and loan programs.
Sun Screen & Photo Permission
I give permission to 2011 Holy Mackerel Kidz Summer Camp to take photos of my child. These photos will be used only for classroom projects, slide shows, and teaching purposes. The photos may be used on our website without listing any of your child’s personal information.
Child’s Name:______
Date:______
Circle the appropriate response!
My Child’s Photo may / may not be used in any form of publication.
Parent’s Signature:______
I hereby give permission for the sunscreen that I have provided
to be used on my child.
Child’s Name:______
Date:______
Parent’s Signature:______