Holy Name School Bobcat Summer Camp
June 5, 2017 - August 4, 2017
7:00 a.m. - 4:00 p.m.
(After-camp care available until 6:00 p.m.)
Ages 3K to entering 8th graders
Dates / Weekly Theme / Field Trip/ ActivityJune 5-9 / World Cultures-Celebration of Nations / Witte Museum
June 12-16 / Music/Theater Arts-Movin’ and Groovin’ / Movie Theater
June 19-23 / Science on the Go / Texas Transportation Museum
(Friday 23rd)
June 27-30 / Technology Challenge Week / Laser Quest
July 3-7 / Earth Week-Growl, Squeak, & Roar / San Antonio Zoo
July 10-14 / History-Time Travelers / Firefighter Museum
July 17-21 / Art-Creative Campers / Art Works Art Studio
July 24-28 / Sports-Fun and Fitness / Silver Stars Basketball (Tues 25th)
July 31-Aug 4 / End of Summer Fiesta! / Field Day/ Water Day
(Activities and field trips subject to change due to weather or other factors)
Join us for a hands-on, activity based summer camp. With weekly themes and Field Trips every Wednesday. Parents may choose to have their child participate in small group tutoring for Math and Language Arts.
One time registration fee: $45
Weekly Camp fee: $150/1 child $260/2 children $370/3 children $480/4 children Includes: Breakfast, snacks, activities, field trip, Friday pizza day, t-shirt, and tutoring if pre selected by parent. Students are required to bring sack lunches Monday-Thursday.
Daily Drop-in Rate: $50
After-camp Care Rate: $5/hour up to 2 hours from 4:00-6:00 daily. Extra charge past 6pm.
All Campers will attend Church every Friday
*3 year olds must be fully potty-trained
Holy Name School Bobcat Summer Camp
2017 Registration Form
For planning purposes' please check off all weeks you are considering attending·
Please include my child(ren) in small group tutoring: (entering grades 1st-8th only)
Student Name Grade Entering
Student Name Grade Entering
Student Name Grade Entering
Student Name Grade Entering
(Circle) Math I Language Arts (Circle) Math I Language Arts (Circle) Math I Language Arts (Circle) Math I Language Arts
HOLY NAME SCHOOL SUMMER BOBCAT CAMP 2017 STUDENT EMERGENCY/HEALTH INFORMATION
STUDENT INFORMATION:
LAST NAME: FIRST NAME: _ DOB: __ GRADE ENTERING: --- M/F
LAST NAME: FIRST NAME: _ DOB: __ GRADE ENTERING: --- M/F
LAST NAME: FIRST NAME: _ DOB: __ GRADE ENTERING: --- M/F
LAST NAME: FIRST NAME: _ DOB: __ GRADE ENTERING: --- M/F
STREET ADDRESS: _ CITY: ZIP:
PARENTAL/GUARDIAN INFORMATION
MOTIIER'S NAME: WORK: CELL: _
E-MAIL: _
FATHER'S NAME: WORK: CELL: _
E-MAIL:
EMERGENCY CONTACTS
IN CASE OF EMERGENCY AND I CANNOT BE REACHED, THE FOLLOWING PEOPLE MAY PICK UP MY CHILD FROM CAMP:
LAST NAME / FIRST NAME / RELATION / PHONEHEALTH INFORMATION (Please continue on back if necessary)
1. List health conditions such as heart disease, diabetes, epilepsy, asthma, eye/ear problems, blood pressure abnormalities, severe food/drug allergies, etc. A note from your child’s physician is required for heart conditions, diabetes, epilepsy, seizures, or asthma & use of inhaler.
2. Is there any need for medication or inhalers at camp? If so, list medication to be taken or kept at camp:
3. Are there any special concerns or limitations regarding physical participation for your child? ______
CONSENT TO TREAT
I, the undersigned, do hereby authorize the officials of Holy Name School Summer Camp to contact directly the person named on this form and do authorize the names of physicians to render such treatments as deemed necessary in an emergency for the health of said child.
In the event physicians, other persons named on this card, or parents cannot be contacted, the school officials are hereby authorized to take
whatever action is deemed necessary in their judgment, for the health of the aforesaid child.
I will not hold Holy Name Catholic School financially responsible for the emergency care and/or transportation for said child.
PARENT SIGNATURE DATE
PHYSICIAN: ______PHYSICIAN PHONE:______
ADDRESS: ______CITY: ______ZIP______
PREFERRED HOSPITAL: ______
ADDRESS: ______CITY: _
INSURANCE COMPANY NAME: ______POLICY NO.: _