St. James United Church Summer Camp Registration Form 2018
Summer Camps
All of our camps are located at St. James United Church with use of the park/splashpad located directly beside the Church. Camp runs from 8:30am-4:00pm each day. Day Camps are open to Ages 4*-11 (*Born in 2014). Week camps are open to Ages 5*-11 (*Born in 2013).
Please complete one form PER child if multiple children from the same family will be attending. Completed forms (Pgs 1-4) can be returned to or returned in person (including payment) to the Church Office (221 Romaine St., M-Th 9am-2pm).
Participation
My child would like to participate in the following camps(Day Camps in Italics). Please check all that apply.
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
705-742-2222
St. James United Church Summer Camp Registration Form 2018
July 5th, 2018: Learn to be a Pirate
July 9th-14th, 2018: Animal Kingdom
July 18th, 2018: Dr. Seuss Day
July 19th, 2018: St. James Olympics
July 23rd-27th, 2018: Superheroes
July 30th-August 3rd, 2018: Once Upon a Fairy Tale
August 8th, 2018: Be Your Own Chef
August 9th, 2018: S.T.E.M. (Scientist Day)
August 13th-17th, 2018: Eco-Adventure
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
705-742-2222
St. James United Church Summer Camp Registration Form 2018
Fees
Fees are due at the time of registration.Payments can be made by cash, cheque (made payable to St. James United Church) or PayPal (). Receipts will be issued upon request.
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
705-742-2222
St. James United Summer Camp Registration Form 2018
Day Camp: 25$/child/day
Week Camp: 125$/child/week of camp ($100/additional sibling/week of camp)
Note: For information regarding Subsidies please contact
Parent/Guardian Consent
I have read through and agree to abide by the St James United Church Camp Policies for 2018 (see attached pages). I understand that any violation of these terms may result in immediate dismissal from camp.
______
(Parent/Guardian signature)(Date)
Photographic Release
I hereby authorize St James United Church to use images or recordings of my child for activities and promotional materials for the Church. In addition, I understand that these images could also be shared with external media organizations, such as newspapers and television stations.
______
(Parent/Guardian signature)(Date)
Camper Information
Child’s Name: ______Age: ______
D.O.B: ______
Child’s Preferred Name:______Gender: M / F (DD/MM/YYYY)
Parent(s)/Guardian(s): ______
Daytime Phone #: ______Alt #: ______
Address: ______PostalCode:______
Email: ______
Preferred Method of Contact (Please circle one): EmailTelephoneEither
Pick Up Authorization: (aside from parents/guardians):
Name ______Phone # ______
Name ______Phone # ______
Name ______Phone # ______
Name ______Phone #______
Emergency Contact:
Name: ______Relationship:______
Phone: ______Alt. Phone: ______
Health Information
Health Card # (optional): ______
Allergies/Dietary Restrictions/Health Concerns: ______
______
______
About my Child/Special Considerations
Please tell us a little about your child (Likes, Dislikes) and any Special Considerations including whether they require additional support/supervision (Eg. Sensitive to Loud Noises, Has an EA at School, Works best in Small Groups)
______
______
______
______
______
______
______
CAMP POLICIES
Campers Possessions:
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
705-742-2222
St. James United Summer Camp Registration Form 2018
Please send the following items with your childdaily:
- Peanut-free lunch & healthy snacks.
- Refillable water bottle. Please send it full; we can refill it at camp.
- Running shoes, sunscreen and a hat
Please do not send the following items with your child:
- Money
- Toys, dolls or stuffed animals.
- Electronic devices.
- Medications (unless prearranged with Camp Director)
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
705-742-2222
St. James United Summer Camp Registration Form 2018
We have a lost and found box for the camp that is located at the camp entrance at the bottom of the stairs. Please check there if your child is missing something. St James United Church is not responsible for any personal items lost or stolen from church property.
Safety:
I understand that every precaution is taken to secure the safety of each child; however in case of an accident, if I cannot be reached, I agree to allow the staff and volunteers of St. James to accompany my child to hospital if necessary, until I can be there, and I agree to release St. James United Church from any liabilities. We offer some snacks at camp and making a snack is one of the activities in our camp rotation. If your child has any allergies, please indicate that on the registration form.
Off-site Activities:
Each day of camp that is sunny, the children will go to a park and splash pad beside St. James. One day per camp, the children will travel to various locations by city bus and will spend the day there. I give permission for my child to participate in these off-site activities. I also understand that these activities are weather permitting and may be cancelled at any time.
Sunscreen:
Children must bring sunscreen to camp every day. This sunscreen needs to cream rather than spray/aerosol, as the children will apply sunscreen inside and the spray sunscreen harms the floor. Should my child need assistance in applying sunscreen, I give permission for the staff and volunteers at camp to assist him or her.
Pickup & Drop off:
Camp doors open at 8:30 am. Camp closes at 4 pm. Please be prompt in picking your child up.
Only those people listed on the registration form as authorized to pick up a child from day camp will be able to leave camp premises with a child. You may update the authorized list at any time by speaking with staff. Notes will be accepted, but may also be confirmed by phone.
Camp Dismissal:
A child may be sent home for any number of reasons including, but not limited to; illness; swearing; violent, inappropriate or abusive behaviour; possession of drugs, alcohol or weapons; vandalism, theft, leaving group or day camp grounds without permission; or noncompliance to rules and regulations of the Day Camp. If called by camp staff I agree to come and pick up my child immediately.
Complaints or Concerns:
Any complaints or concerns about the day camp, including programming, child supervision, and discipline techniques can and should be discussed with Lacey Dummitt- Camp Director at 742-2222 or by emailing .
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
705-742-2222