Super Summer Day Camp Registration 2023

Super Summer Day Camp Registration Form 2023
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Day Camp Registration

June 12th - August 18th
Expected Start Date: (First day of camp June 12th)

MonthDayYear
CMS last day of school June 7th
Expected Departure Date (Last day of camp August 18th)

MonthDayYear
CMS first day of school August 28th
Grade your student is going into this Fall*
Will your child require Early drop off or Late pick up? *
Early Drop off 7:30am. Late pick up 3:30pm-5pm.
What weeks are you looking for care? *
Student Information
First Name*
Last Name*
Gender*

FemaleMale
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Health Care Provider*
Doctors Name*

First NameLast Name
Doctors Phone Number*
Parent/Guardian Information 1
Full Name*

First NameLast Name
Phone #*
Can this phone receive Texts?*

Yes, but I prefer phone callsYes, and I prefer textsYes, No preferenceNo
Work
E-mail*
example@example.com
Address - Same As Child*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 2
Full Name

First NameLast Name
Phone #
Can this phone receive Texts?

Yes, but I prefer phone callsYes, and I prefer textsYes, no preferenceNo
Work
E-mail
example@example.com
Address - Same As Childs

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Infomation
Would your child like to be in a group with a friend?

YesNo
If yes, name and age of friend(s)?
Does your child have any allergies?*

YesNo
If yes please list, including any food or drug allergies.
Does your child have any medical conditions?
Does your child require any medication? If yes, please list these medications.
Do you authorize us to administer the medications listed above?

YesNo
Please list the people authorized to pick up your child and their relationship to your child. *
Are their any special instructions you would like our teachers to know about?*
If yes, please list
Are you a member of Greater Life Church?
Emergency Contact - Other than Parent/Guardian
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone*
Additional Number
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

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Application FeeA $30 application fee will be charged per student applying. This charge is non-refundable.

$30.00

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Total

$0.00

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Super Summer Day Camp Registration Form 2023

Day Camp Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian

Credit Card