Summer Camp 2023 Detailed Registration Form

Summer Camp Registration

June 20 – August 11, 2023
Child Information

(one application for each child being registered)
Child's Name*

First NameLast Name
Gender

MaleFemale
Birth Date*

MonthDayYear
Age*
T-shirt size*
Grade*
Which grade will be completed June 2023?
My child attended the 2022–2023 school year at…*
Name of School
(If applicable) My child is registered to attend Summer School at…
Name of School
Does your child have special needs? (If yes, please call (703) 897-1100 to discuss the application process for children with special needs, so we may determine how we might best meet your child’s needs.)*

YesNo
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Family Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Parent/Guardian Information
Parent/Guardian 1*

First NameLast Name
Relationship*
E-mail*

Confirmation Emailexample@example.com
Cell Number*
Work Number*
Parent/Guardian 2

First NameLast Name
Relationship
Email
Cell Number
Work Number

Summer Camp Rates

Select Weeks Attending Summer Camp*

6/5 – 6/9 †6/12 – 6/16 †6/20 – 6/236/26 – 6/307/3 – 7/77/10 – 7/147/17 – 7/217/24 – 7/287/31 – 8/48/7 – 8/118/14 – 8/16 †
† only full day care available

Optional June 26 – July 28 Summer Enrichment Program

Please call us at (703) 897-1100 for more details about this Summer School program!

Will your child be attending our June 26 – July 28 Summer Enrichment Program?*

YesNo
Informed Consent and Acknowledgement

Upon completion of the registration process, a parent portal will be set up for me so I can see my account and make credit card payments. I may also pay by money order made payable to “Cornerstone Christian Academy.” Personal checks and/or cash are not accepted.

The one-time registration fee for my child to attend Cornerstone Summer Camp is non-refundable.

I understand that I will be charged for weeks that I sign up for, and that all schedule changes must be made in advanced, in writing, to the school office. I am responsible for each full week’s tuition if I do not submit written schedule changes in advance. I also understand I will be responsible to pay for the weeks I have committed to.

I understand that this application is not complete without my signature and will be returned to me if I have not completed all spaces and signed below.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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Summer Camp Registration