Summer 22 App

Summer 2022
Summer Cost

Ages 6 mo. - 2nd Grade (Completed)

June (paid in advance): $285

July (paid in advance): $285

June & July (paid in advance): $550

Weekly Cost: $90

Session Fees are NON-REFUNDABLE
Please select the week(s) your child will be attending. Week of:

June 1 June 6 **Week of VBS, includes Monday 9-2** June 14 June 28 July 5 July 12 July 19 July 26
Name of Child
Date of Birth:

Month Day Year
Date
Age:
Grade:
Name of Child
Date of Birth:

Month Day Year
Date
Age:
Grade:
Name of Child
Date of Birth

Month Day Year
Date
Age
Grade
Best Person and Phone Number to Contact while child is in our care:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mother's Name
Mother's Cell
Please enter a valid phone number.
Cell Carrier
Mother's Employer
Work Number
Please enter a valid phone number.
Mother's Email
example@example.com
Are you a member of SGBC?

Yes No
If no, are you a member of another church? If yes, where?
Father's Name
Father's Cell #
Cell Carrier
Father's Employer
Work Phone
Please enter a valid phone number.
Father's Email
example@example.com
List 2 people & their relationship to the child who might be called in an emergency if parents cannot be reached.
Name
Phone #
Name
Phone #
Name of people other than parents who have permission to pick up the child.
1
2
3
Do any of the children listed about have any allergies? (If yes, please list child's name, allergies, and symptoms below:
Anything special we should know about the child?
Should be Empty: