O.D. Epps Summer Youth Program Registration Form

O.D. Epps Summer Youth Program Registration

820 E. Wintergreen Rd. * Cedar Hill, TX 75104 * 972-230-4477
Welcome to O.D. Epps Summer Youth Program

Dear Parents/Guardians,

Attached please find information and forms pertaining to the O.D. Epps Summer Youth Program. These forms should be completed and submit no later than Tuesday, May 30, 2023. Please note due to COVID19, field trips will be limited and various fun and educational things will be bought to the location. This year’s tuition cost is $125.00 per child/per week.

If you have any questions or require additional information, please contact our office.

COMMUNITY BAPTIST CHURCH

820 E. Wintergreen Road

Cedar Hill, Texas 75104

(972) 230-4477

MANDATORY PARENTS MEETING

The O.D. Epps Summer Youth Program Parents’ meeting will be held on Tuesday, May 30, 2023, after camp end the Sanctuary of Community Missionary Baptist Church at Cedar Hill, 820 E. Wintergreen Road, Cedar Hill, TX 75104.

PROGRAM OBJECTIVES

The O.D. Epps Summer Youth Program is designed to enhance the educational, spiritual, emotional, and physical growth of each child. The O.D. Epps Summer Youth Summer Program is NOT an extension of the Community Missionary Baptist Church. This is a youth program with activities ranging from recreational to spiritual. The Program is not a Day Care Facility.

PARTICIPANTS
All youth of the Community Missionary Baptist Church, Nova Academy, and well as those from the community, are welcome to attend.

· The program is open to Age 5 to age 12. (NO EXCEPTIONS).

· Registering a child age 5 requires a copy of the child’s birth certificate (NO EXCEPTIONS).

· No sick child will be allowed to attend the camp.

REGISTRATION/PAYMENT

Non-Refundable Deposit: $75.00 per household - (due at time of registration) One T-Shirt included

$10.00 per T-Shirt for each additional child

Weekly Payment: $125.00 per child - (due on Mon – No Later than 5pm)
$230.00 two kids - (same household) $340.00 three kids - (same household)
$35.00 per day Drop-Off Rate
Late Payment Fee: $10.00 per child and $5.00 additional every 15 mins
(DUE WITH ALL LATE PAYMENTS)

PAYMENT OPTIONS

Cash Only/Money Order – No Partial Payments Will Be Accepted

SPECIAL NOTES: Weekly payment is $125.00. You are responsible for the entire weekly payment even if your child only attends one day.

THEME: Basic Training

Building up a new generation of young Christian Soldiers

Scripture: Proverbs 22:6 “Train up a child in the way that he should go: and when he is old he will not depart from it.”

MANDATORY PARENT’S MEETING

O.D. Epps SYP parents’ meeting will be held on Tuesday, May 30, 2023 after ending of camp in the Sanctuary of Community Missionary Baptist Church at Cedar Hill, 820 E. Wintergreen Road, Cedar Hill, TX 75104.

PROGRAM OBJECTIVES

The O. D. Epps Summer Youth Program (SYP) is a ten-week program designed to enhance the spiritual, emotional, and physical growth of each child. This is a children’s program with activities ranging from recreational to spiritual. Please remember that the SYP is not a daycare facility.

PARTICIPANTS

*The program is open to all youth ages 5 years old through 12 years old. (No Exceptions).

*Parents enrolling a 5-year-old must provide original birth certificate and a copy will be made.

REGISTRATION AND FEES

A Non-refundable registration fee in the amount of $75.00 per household is required upon receipt of packet. Weekly payments will be due on Mondays, no later than 5pm. Only cash or money orders will be accepted; NO CHECKS. Our objective is to defray expenditures such as food, utilities, salaries, equipment purchases, etc., not to make a profit. THERE WILL BE A $10.00 CHARGE FOR PARENTS WHO ARRIVE AFTER 6 PM AND AN ADDITIONAL $5.00 EVERY 15 MINUTES THEREAFTER. (Late Fees must be paid the following business day.)

IMPORTANT INFORMATION - NOT FOR TAX PURPOSES

Summer Youth Program (SYP) is not a day care operation nor is it an extension of the Community Missionary Baptist Church. Therefore, the Summer Youth Program does not have a tax identification number for income tax purposes. As a result, the SYP cannot give you a number for deduction on your income tax statement. Likewise, the associated fees cannot be considered a contribution because you are receiving services in return for the fees. Therefore, the SYP WILL NOT issue a contribution statement reflecting payments made.

However, the SYP will issue a receipt at the time of each payment. If you choose to submit that record to the Internal Revenue Service (IRS) as a child-care deduction for tax purposes, please understand that the church will not be responsible for substantiating the expressed fee.

O.D. EPPS CLOSE FOR HOLIDAYS

SYP will be close on Monday, June 19, 2023 and Tuesday, July 4, 2023.

Parental/Guardian Medication Consent Form
Name of Student

First NameLast Name
Date of Birth:

MonthDayYear
Date
Grade:
I, blanks (parent or guardian) give permission for O.D. Epps Summer Youth Program or designated administrator to dispense over-the-counter medication to my child _________________________________ during the 2023 summer program. I understand I must provide the medication to the camp in its original container.
Medication allergies:
Name of medication
Directions:
Reason(s) for medication
Signature of Parent/Guardian

Clear
Date

MonthDayYear
Date
Students are not allowed to carry medication on them and must keep all medication in the office. O.D. Epps Summer Youth Program is prohibited from administering any medication without a completed and signed parental consent form.

PARENT/GUARDIAN - RELEASE FORM

REQUIRED FOR STUDENT PARTICIPATION IN

O.D. EPPS SUMMER YOUTH PROGRAM AND

FIELD TRIP/TOUR/EXCURSION

{1Child} is my child and is now under my control and in my custody.

I/we desire my child to participate in the O.D. Epps Summer Youth Program. In consideration of my child being accepted by the O.D. Epps Summer Youth Program, I/we hereby relieve and release Community Missionary Baptist Church, its directors, officers, employees, agents, and servants, together with those persons assisting with any phase of the O.D. Epps Summer Youth Program, from any and all liabilities, claims, and responsibilities for my child participating in the O.D. Epps Summer Youth Program. I/we further release all of these parties from liability, by reason of any accident or injury suffered by my child while participating in the O.D. Epps Summer Youth Program.

I/we desire my child to go on any and all field trips/tours/excursions and participate in any and all activities of the O.D. Epps Summer Youth Program. I/we agree that in allowing my child to go on these trips I/we will hold Community Missionary Baptist Church, its Directors, officers, employees, and servants, together with those persons assisting with any phase of the Summer Program harmless from any and all liability, claims, and responsibility for making such trips and activities. I/we further release all of these parties from liability, by reason of any accident or injury that might occur while on the trips or participating in such activities.

The undersigned further hereby agree to indemnify and hold Community Missionary Baptist Church, its directors, officers, employees, agents, and servants harmless from all claims hereinafter made or asserted on behalf of said child-participant.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PARENT/GUARDIAN APPROVAL FORM
Parent's Password:
Child (1)*

First NameLast Name
Age:*
Child (2)

First NameLast Name
Age:
Child (3)

First NameLast Name
Age:
Please list person(s) that have your permission to pick up your child/children from O.D. Epps Summer Youth Program.
1. (Parent) Name:*

First NameLast Name
Driver's License No.:
2. (Parent) Name:

First NameLast Name
Driver's License No.:
3. (Parent) Name:

First NameLast Name
Driver's License No.:

RULES OF CONDUCT
Please check*

T-SHIRTS We ask that students participating in the Summer Camp purchase a t-shirt that will be worn when we go on our field trips. This is to help us identify our students and keep close track of them. Fill out the form below and return with the registration forms.

Please indicate your child's t-shirt size.

Youth S | Youth M | Youth L | Youth XL | Adult S | Adult M | Adult L
Child's Name*

First NameLast Name
Size*
Child's Name

First NameLast Name
Size
Child's Name

First NameLast Name
Size

O.D. Epps Summer Youth Program Photo Media Release Form

O.D. Epps Summer Youth Program strives to provide a safe, secure, educational, and fun environment for visiting Pre-K -7th students. We ask that all students visiting campus have the following signed by a parent or guardian:

Photo, Media, and Copyright Release

I grant O.D. Epps Summer Youth Program my permission to photograph, videotape, and/or audiotape my child during activities at O.D. Epps Summer Youth Program. These photographs/videos/audios will remain the property of O.D. Epps Summer Youth Program and may be used in advertising or marketing campaigns on O.D. Epps Summer Youth Program’s websites and promotional and informational material including, but not limited to, flyers, brochures, newsletters, emails, advertisements, newspaper articles, TV or cable interviews/promotions. I understand my child will not be identified by name unless I give my express permission. I hereby waive and release on behalf of my child, any rights to compensation for, or ownership of, such images and/or sounds.
Child Name*

First NameLast Name
Parent/Legal Guardian*

First NameLast Name
Date*

MonthDayYear
Date

Daily Outline

Doors open 6:00 am

Devotion/prayer 8:00-8:30am

Breakfast served at 8:35-9:15am

Bathroom break 9:15-9:30am

Daily exercise 9:30-10:10am

Enrichment classes start at 10:15-11:55am

Lunch served 12:00-12:40pm

Classes resumes 12:45-2:00pm

Relax movie time 2:15-3:30pm

Supervised Free play 3:30-6:00pm
Should be Empty:

O.D. Epps Summer Youth Program Registration

STUDENT REGISTRATION FORM

ALTERNATIVE EMERGENCY CONTACTS

HEALTH & MEDICAL INFORMATION