FUMC Half-Day Camp for Elementary Remote Learners Registration Form

FUMC Half-Day Camp for Elementary Remote Learners

Monday - Friday | 8:30 am - 12:00 pm
Thank you for your interest in our Half-Day Camp. Our goal is to provide a structured learning environment for your child while your child's school operates in remote learning. We will assist and facilitate the lesson plans of your child's teacher(s).

Registration Details:
- Please register using the form below.
- Fees may be turned in at the drop-off line on Monday or mailed to:
FUMC, PO Box 1423, Wilson, NC 27894
- Payment method: cash or check accepted. Please make checks payable to FUMC and write "Remote Learning" on the memo line.
Fees:
- Camp Fee: $75.00 per student per week (discount available for families with multiple children)
- Payments are due by Monday of each week
Contact:

For more information, please contact:

Vickie Franks at vickiebfranks@fumcwilson.org

Lorie Daniel at loriedaniel@fumcwilson.org

or call FUMC at (252) 237-6121 and ask for Vickie or Lorie

Blessings,

Vickie Franks, Director of Children's Ministries, FUMC

Lorie Daniel, Director of FUMC Weekday Preschool
Camper Information

Please submit one form per camper
Camper Name: *

First Name Last Name
Current School Grade: *

Kindergarten First Grade Second Grade Third Grade Fourth Grade Fifth Grade
Date of Birth: *

Month Day Year
Date
Current School: *
Name of Elementary School
Medical or Developmental Issues (allergies, hearing, eyesight, behavior, attention deficit, etc.): *

Tell us about your child. How has he/she responded to online learning?: *
Name(s) & Age(s) of siblings:
PARENT/GUARDIAN INFORMATION
Mother's Information: *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City State

Zip Code
Home Phone Number: *

Area Code Phone Number
Work Phone Number: *

Area Code Phone Number
Cell Phone Number: *

Area Code Phone Number
E-mail: *
Father's Information: *

First Name Last Name
Address (if different):

Street Address

Street Address Line 2

City State

Zip Code
Home Phone Number (if different): *

Area Code Phone Number
Work Phone Number: *

Area Code Phone Number
Cell Phone Number: *

Area Code Phone Number
E-mail: *
example@example.com
Child lives with: *

Both Parents Dad Mom
Emergency Contact (other than the parent above)

In the case that we are unable to reach either parent in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact 1 Name: *

First Name Last Name
Emergency Contact Number: *

Area Code Phone Number
Relationship to Camper: *
Emergency Contact 2 Name: *

First Name Last Name
Emergency Contact Number: *

Area Code Phone Number
Relationship to Camper: *
Is there a court order preventing anyone from picking up your child? (If a court order exists, we will need to be provided with a copy to keep on file.): *

Yes No

Authorization to seek medical and dental treatment:
Should an emergency arise, I authorize FUMC Half-Day Camp for Elementary Remote Learners to seek medical and/or dental care for my child at the nearest medical facility. I undertand that I am responsible for any financial expenses that may incur.
Authorization: *

I GIVE permission for FUMC to seek medical and/or dental care for my child at the nearest medical facility. I DO NOT give permission for FUMC to seek medical and/or dental care for my child at the nearest medical facility.
Camper's Physican: *
Physican's Phone Number: *
Camper's Dentist: *
Dentist's Phone Number: *

Photographic & Media Consent
You are being asked to give consent for the collection and use of your child’s personal images by photography or video recording.

If you give consent, you are acknowledging that these images may be used by FUMC for instructional and publicity purposes.

No personal information, such as names, will be used in any publications unless express consent is given.
Authorization: *

I HEREBY GIVE consent to the collection and use of my child’s personal images by photography or video recording. I DO NOT give consent for FUMC to collect and use my child’s personal images by photography or video recording.

COVID-19 Safety Plan
As you know, there are quite a few challenges that we face as we work to adapt to the impact the current pandemic has made on our way of living. While we focus on your child's education and need for a structured learning environment, our first priority is the safety of your children and our staff. Rest assured that we have been worked diligently on our plans to open the Blackburn Building for our weekday preschool and our half-day camp. We have been compiling information from local, state, and federal health experts as well as the NC Department of Public Instruction and Wilson County Public School system in an effort to be proactive and prepared so we can quickly adapt as necessary.

Plan Details to date:
- Purchase cleaning and disinfecting products needed to maintain new standards.
- Clean and sanitize all camp areas with solutions approved by the EPA for eliminating a variety of bacteria and viruses, including COVID-19.
- Campers will arrive and be dismissed at the entrance/exit gate to the church playground. Classrooms for our camp will be on the second floor of the Blackburn Building.
- Parents/Caregivers will not enter the building in an effort to reduce the potential spread of illness. Campers will use hand sanitizer and have their temperatures taken upon arrival. Any child exhibiting symptoms (i.e., cough, fever of 100 degrees or more, unusual fatigue, congestion/runny nose, etc.) will not be allowed to stay and will need to quarantine for the recommended period of time.
- Once inside the building, campers will interact only with the campers and teachers in their classroom.
- Campers will wash their hands or use hand sanitizer when moving to different areas within the classroom, before and after eating or drinking, and after each trip to the bathroom.
- Teachers will wash their hands or use hand sanitizer when they arrive at camp, before and after working with campers, when moving to different areas within the classroom, before and after eating or drinking, and after each trip to the bathroom.
- Teachers and campers will wear face masks at all times (except when eating snacks).
- All surfaces and materials will be cleaned and disinfected throughout the day as needed and at the end of each day.
- Campers will have their own individual supplies and will not share supplies. Supplies may be left at the church during the week.
- Stair rails, door handles/knobs, etc. will be cleaned and sanitized regularly (daily or weekly depending upon product specifications) to prevent the spread of illness.
- In the event there is a positive case of COVID-19, the camper's class will be closed and the campers and staff in that class will be quarantined for the recommended period of time (currently 10 days). The classroom will be completely sanitized before campers return.
This plan will continue to evolve as necessary, and we will work to update you as quickly as possible. Please feel free to contact us with any questions or concerns you have about our camp.

Thank you!

Vickie Franks, Director of Children's Ministries, FUMC

Lorie Daniel, Director of FUMC Weekday Preschool
Acknowledgment of COVID-19 Plans: *

I have READ and understand the FUMC Half-Day Camp for Elementary Remote Learners' safety plans and precautions addressing the COVID-19 pandemic.

COVID-19 Assumption of Risk Statement
In opening our church for our FUMC Half-Day Camp for Elementary Remote Learners, First United Methodist Church has implemented many recommendations from the State of North Carolina, Federal Government, and the North Carolina Conference of the United Methodist Church to prevent or limit the spread of COVID-19.

By enrolling your child in our camp, you and your family are making a fully informed and voluntary assumption of risks, including but not limited to, any loss, damage, expense, or injury that may occur as a result of your child attending FUMC Half-Day Camp for Elementary Remote Learners, due to COVID-19 and any related illnesses that may result from possible exposure to COVID-19.

Entering your name and signature below confirms that you have read, understand, and agree with above.
Name *

First Name Last Name
Signature *
First United Methodist Church

Children's Ministries 100 Green Street NE Wilson, NC 27893
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FUMC Half-Day Camp for Elementary Remote Learners

Camper Information

PARENT/GUARDIAN INFORMATION

Emergency Contact (other than the parent above)

Authorization to seek medical and dental treatment:

Photographic & Media Consent

COVID-19 Safety Plan

COVID-19 Assumption of Risk Statement

First United Methodist Church