2023 Love & Care Exceptional Children's Day Camps Application

2024-2025 Love & Care ECC Day Camps Application

(Please print and fill in all information completely
Child's Name*
Sex*

MaleFemale
Ethnicity
Child's Exceptionality
Is Your Love Bug Potty-Trained?*
Home Address
School
Grade
IEP
or 504
Date of Birth

MonthDayYear
Date
Age on first day of camp
Parent(s) Name
Phone Number(s)
Primary Email Address (Invoices will be sent to this email address)
example@example.com
Will any additional siblings attend?*
If so, please list full name(s) and complete one application per child
Please separate each name with a comma

Registration Fee: $50. This applies to NEW enrollees only. Upon attending your first Day Camp, your child must pay the registration fee in cash.

We reevaluate our pricing semi-annually. Our goal is to keep costs low while offering excellent, quality-rated services.

School Days Out are from 8:30 AM-3:30PM. Aftercare is available until 6:00 PM for an additional fee, for select Day Camps. All event/day camp prices are available under the Events tab on our website. We do not offer after/late care for every Day Camp. The time slots available will be under the pass information on our website.

*Please pack a Sack Lunch*

Non-Potty Trained or Medically Complex is Standard Price +Additional Fee. PLEASE NOTE: NON-POTTY TRAINED SLOTS ARE FOR AGES 9 AND UNDER.

*School Days Out Includes Breakfast and Afternoon Snack*

4-year olds permitted to attend 4 hours per day, unless pre approved by Director.

School Days Out pricing varies depending on the number of days. During the school year, we follow the calendar for Columbia County Schools.
Please check which Events you would like for your Love Bug to attend:

“Will You Be My Valentine?” February 17, 2023 Cost: $75“When I Grow Up, I Want To Be A...” Career Day February 20, 2023 Cost: $75“Digital Learning Day” March 10, 2023 Cost: $75“You’re My Lucky Charm” March 13, 2023 Cost: $75“Chillin With My Peeps” Spring Break April 3-7, 2023 Cost: $300

EMERGENCY CONTACTS

(Others that may be reached, if we cannot reach you)
Emergency Contact #1 Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Emergency Contact #2 Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Emergency Contact #3 Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.

Medical Information
Doctor's Name
Phone
Health Insurance Co.
Policy Number
Allergies
Medications
Special Needs
(Anything we should know about your child to ensure he/she has a good camp experience, private meetings with Director available upon request.)
Pick Up Information
People authorized to pick up child
People NOT authorized to pick up your child
People authorized to pick up child
People NOT authorized to pick up your child
People authorized to pick up child
People NOT authorized to pick up your child

Camper Personal Information
Please describe your child's Special Needs
Please describe any triggers and what makes your child happy.
When upset, what behavior does your child display?
What calms your child down?
Allergies
Additional Details (Please Share Information Regarding Behaviors and Mannerisms)

Disclosures
Due to preplanned events and scheduled staffing, we DO NOT issue any REFUNDS OR CREDITS. Please finalize your plans before purchasing passes.

Late pick-up will result in a $50 per hour fee. Late fees will be assessed 15 minutes after the selected Camp/Event has ended.

**NO PERSONAL ELECTRONICS PERMITTED i.e., Cell Phones, iPads, Gaming Systems, etc., except those needed for Non-Verbal attendees. Love & Care ECC is NOT responsible for devices, toys, or other personal items brought in that are not allowed. If items are lost, misplaced by your Love Bug, or damaged we do not replace or assume the cost for personal items.

**IF YOUR CHILD DAMAGES ANY PROPERTY THAT BELONGS TO LOVE AND CARE ECC OVER $50.00, YOU WILL RECEIVE PHOTO PROOF, ALONG WITH AN INVOICE FOR THE PROPERTY THAT WAS DAMAGED. AN INTERVENTION PLAN MUST BE PUT IN PLACE AND DAMAGED PROPERTY MUST BE PAID IN FULL BEFORE YOUR CHILD CAN RETURN TO OUR FACILITY.

Sick Policy

We strive to maintain an immaculate, clean, and sterile environment. It is very important that if your Love Bug is not feeling well or someone in your home is experiencing a severe viral infection that you keep your Love Bug at home. If he/she has had any of the following, they should be kept at home: Persistent coughing and runny nose, sore throat, fever of 100 degrees or greater, vomiting or diarrhea within 24 hours, rash, eye infection, and head lice. If your Love Bug is present and we experience any sick symptoms, we will contact you for pickup. Please DO NOT give him/her a fever reducer or antacid and bring them to camp. Also, if your Love Bug is not his/her normal self or lethargic we will call for pickup to prevent what may be the beginning stages of an infection. Viral infections spread FAST and many of our kids have delicate immune systems, so please be considerate of others.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
As the parent/guardian of the listed child, I authorize my child to participate in all activities. I permit Love & Care Exceptional Children’s Childcare LLC., to administer first aid, and in the event of an emergency, to secure a physician for any emergency treatment needed for my child. I understand that a conscious effort will be made to locate me or a close relative before any action is taken. I understand and accept that this expense is my responsibility. I also understand that it is my responsibility to carry primary accident and health insurance.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Photography Release

I understand that photos may be taken and used for websites, social media, and promotional purposes. If I object, I have marked the * no photos/no videos option below.
Photography Release

I prefer that no photos or videos be used.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Notice of No Liability and Acknowledge

I understand that I am being informed in writing, by signing this acknowledgment that this facility does NOT carry liability insurance to protect my child in the event of Covid-19, injuries, illnesses, accidents, etc. Love & Care Exceptional Children’s Childcare LLC., Love & Care Exceptional Children’s Summer Camp LLC., Love & Care Exceptional Children’s Love Bug Music Club, The T.Y.L.E.R Movement, or any of its Owners, Staff, Volunteers, or other affiliates are NOT responsible for injuries, illnesses, accidents, medical costs, lost wages, etc.
Signature

Clear
Date

MonthDayYear
Date
Bright From the Start Exemption Acknowledgement

This acknowledgment serves as a notice, that Love & Care Exceptional Children’s Childcare LLC., is NOT a licensed daycare facility. I understand that this program is not required to be licensed by the Georgia Department of Early Care and Learning and is exempt from state license requirements. The facility has been inspected by Columbia County Officials and each person volunteering and/or employed has gone through a thorough background check. Please sign below as an acknowledgment that you have received this notice.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Please read and initial the following statements:
There is a $100 fee charged for ALL returned checks.
No pro rating, one day is considered a full week. NO REFUNDS.
I received my parent handbook and understand that all rules are contained in it.

Intervention Behaviors (Verbal and/or Written Notification): This notification is only so that we can work together as a team, to reduce certain behaviors.
- Excessive screaming
- Sensory overload
- Perseverative behaviors that interfere with the class such as noises or singing
- Running away from staff (That puts themselves in danger)
Behaviors that Require a Parent Pick-Up:

Behavior that continues even after interventions have been tried and affects the safety of the child, other children, and/or staff. Some of these behaviors may include intervention behaviors listed above, as well as:
- Self-injurious behaviors
- Fighting with another student or staff member
- Inappropriate language
- Continuous non-compliance
- Spitting and/or intentionally using bodily fluids to be defiant
- Aggressive behaviors
Expulsion Behaviors: ALL Behaviors listed above, as well as:
- Repeated behaviors that require a parent pick-up and have not responded to
- Multiple interventions
**Aggressive behaviors towards Staff or fellow Consumers could be cause for expulsion. The program facility reserves the right to add to or change this list at any time*** Parents please be sure that you have read and understand the behavior policy. Any time an attendee is exhibiting behaviors that could injure themselves, staff, or other attendees or damage the facility or community property, Staff will call for the attendee to be picked up. Please understand that Love & Care Exceptional Children’s Childcare LLC. is not staffed to regulate severe behavior needs, as we are not a Behavioral Clinic or Therapy Center.
Does your child have a behavior plan? *
I have read the attached copy of the behavior policy. I understand and agree with the behavior policy at Love & Care Exceptional Children’s Childcare LLC.
Parent/Guardian Signature

Clear
Date*

MonthDayYear
Date
Should be Empty:

Medical Information

Pick Up Information

Camper Personal Information

Disclosures