CPCA SUPER SUMMER CAMP 2022

I. GENERAL INFORMATION

DATES: June 20th - July 15th
HOURS: 7:00am - 3:00pm / 7:00am - 5:30am
GRADES: From Kinder to 6th grade
ENROLLMENT DEADLINE: Limited space. Enrollment is open to the Community.

REGULAR FEES (Per Camper)
Weekly Tuition:
From 7am to 3pm: $130.00.
From 7am to 5:30pm: $140.00

One-time Registration Fee (non-refundable): $80.00 per camper (Includes a summer shirt an a 18oz water bottle)

Weekly Cafeteria Package: included
Extra Summer Camp Shirt: $15
A Summer Drawstring bag or an aditional 18oz Water bottle: $7.00

Payments can be made in person at the school 8755 SW 16th Street, Miami, FL 33165 or by phone calling at 305.559.9409

II. CAMPER INFORMATION
Please select the weeks that your child will be attending:

Week 1 (June 20th - June 24th) Week 2 (June 27th - July 1st) Week 3 (July 5th - July 8th) Week 4 (July 11th - July 15th)
Camper's Name: *

First Name Last Name
Gender: *
Camper's Age: *
Camper's Date of Birth: *

Month Day Year
School Name: *
Current Grade Finished: *
Camper's Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

III. FAMILY INFORMATION
Parent/Guardian 1: *

First Name Last Name
Cell Number: *
Please enter a valid phone number.
Email Address: *
Home Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian 2:

First Name Last Name
Cell Number:
Please enter a valid phone number.
Email Address:
Home Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

IV. PICK UP AUTHORIZATION INFO
Pickup Authorization Person 1: *

First Name Last Name
Relationship to the Camper: *
Phone Number: *
Please enter a valid phone number.
Pickup Authorization Person 2:

First Name Last Name
Relationship to the Camper:
Phone Number:
Please enter a valid phone number.
Pickup Authorization Person 3:

First Name Last Name
Relationship to the Camper:
Phone Number:
Please enter a valid phone number.

V. HEALTH INFO
Child Physician's Name: *

First Name Last Name
Physician's Phone Number: *
Please enter a valid phone number.
Please advise us of any learning disabilities, emotional, or physical conditions to assist us in providing the best camp experience for your child:
List any medications which your child will bring with him/her to camp.
Medication 1:
To be given When/How 1:
Medical Condition 1:
Medication 2:
To be given When/How 2:
Medical Condition 2:
ALLERGIES: (List all known allergies or dietary restrictions)
Medication Allergies:
Describe Reaction and Management of the Reaction:
Food Allergies or Dietary Restrictions:
Describe Reaction and Management of the Reaction:
Other Allergies (include insect stings, hay fever, asthma, animal dander, etc.):

VI.EMERGENCY TREATMENT INFORMATION!
Please Read and Sign Below

Informed Consent for Emergency Treatment: In the case of an emergency and if I cannot be reached, I authorize the staff of Coral Park Christian Academy Super Summer Camp to obtain whatever medical treatment he/she deems necessary for the welfare of my child. I further understand and agreethat I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment regardless of whether or not my medical insurance would cover such charges and fees.
Name of Parent/Guardian: *

First Name Last Name
Date: *

Month Day Year
*

Clear

VII.GENERAL WAIVER
I,   First Name   Last Name   the undersigned, the parent/guardian of the child named below; do hereby consent to this child’s participation in the 2022 Summer Camp program. I acknowledge that participation in this program involves light to vigorous activity and includes the possibility of injury. I am aware that there are inherent risks associated with participation in Coral Park Christian Academy Summer Camp, parties, and/or use of the play area, and inflatable equipment, and I, on behalf of myself and the participants(s) named below, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants. I grant program officials the authority to obtain emergency medical treatment as necessary to ensure that the child named below is safe from further injury. I am aware of no physical or other reasons why this child should not participate in camp programs and related camp functions. I will impress upon the child the importance of following camp rules, regulations, and instructors' directions. In consideration of the camp allowing this child to participate in camp programs, I agree to hereby release and hold harmless, Coral Park Christian Academy and Coral Park Community Outreach their affiliates, officers, members, agents, employees, other participants, and sponsoring agencies from and against all claims, injuries, liabilities, or damages arising out of or related to our participation in any and all summer camp activities, parties, the use of the play area, and /or inflatable equipment.

TRANSPORTATION WAIVER

I,   First Name*   Last Name*   acknowledge that my child will be participating in activities, field trips, and events organized by Coral Park Christian Academy Summer Camp program. I am aware that the participation of my child is outside the scope of their daily routine. I give permission for my child to travel by a MDCPS approved bus to the desired destinations.

SWIMMING WAIVER

(Only applies to campers in grades 2, 3, 4, 5 & 6)

I,     DON’T ALLOW my child to use the swimming facilities that are scheduled by the summer camp program. My child is not a good swimmer.

I,         ALLOW my child to use the swimming facilities that are scheduled by the summer camp program. My child is a good independent swimmer.
(Only applies to campers in grades 2, 3, 4, 5 & 6) *

I DON’T ALLOW my child to use the swimming facilities that are scheduled by the summer camp program. My child is not a good swimmer. I ALLOW my child to use the swimming facilities that are scheduled by the summer camp program. My child is a good independent swimmer.
Please, write any additional information here:

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VIII.INSURANCE WAIVER

My/our child is covered under our family health insurance plan which has limits of not less than $25,000
Company Name *
Police Number *

IX.IMPORTANT CAMP POLICIES AND RULES
Please initial each number below
Type Initial* CAMP T-SHIRTS: Campers must wear their camp T-shirt everyday. Campers who come to camp without their camp T-shirt will be given a shirt and the parent will be charged $15.00. Please have your child’s T-shirt tag marked with your child's name.

* REGISTRATION FEE: The $80.00 Summer Camp Registration must be paid in advanced, this will include one summer shirt, an 18oz water bottle and a String Bag. Extra shirts can be purchased in the main office for $15.00 and also a drawstring bag / extra 18 oz water bottle, can be purchase for $7.00. Registration Fees are Non-refundable.

* WEEKLY TUITION : Tuition payment of $130.00/140.00 are due on Mondays of every week. Payments made after Tuesday at 5:30 pm will be charged a $15.00 late fee.

* FIELD TRIPS: All campers must attend the field trips. If campers do not want to attend a field trip they must not come to camp on that specific day. All campers must arrive on time on field trip days. Campers who arrive late for a field trip will be left behind and will need to go back home with the parent. Poor weather conditions can force outdoor field trips to change and be re-routed to an indoor activity. Parents are encouraged to contact the Main Office and receive updates on the field trip status.

* LATE PICK-UP: (Please read carefully) Parents that pick-up their child(ren) after 5:30 p.m. will be charged $1.00 PER MINUTE. NO EXCEPTIONS!

* SWIMMING POOL POLICY: We usually schedule several aquatic field trips for the summer. Campers in grades 2, 3, 4, 5, & 6 that are good swimmers may participate in both the swimming pool and water playground areas of parks. Those campers who are not good swimmers may not participate in any swimming pool activities. Campers that are not given permission by the parent will remain in the water playground area only. No Swimming.

* SUMMER CAMP HOURS: We are open from 7:00am until 5:30pm. Parents can choose their care schedule from: 7:00am - 3:00pm or 7:00am to 5:30pm. Our Summer Camp starts on June 20th and ends on July 15th 2022. We will be closed on July 4th, Independence Day holiday.
I ACKNOWLEDGE AND CONFIRM THAT I HAVE READ THIS WAIVER PRIOR TO SIGNING BELOW.
Parent/Guardian Name: *

First Name Last Name
Date: *

Month Day Year
Parent/Guardian Signature: *

Clear
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