Summer Camp 2023 Enrollment Form

Summer Camp Registration 2023

Santa Cruz Learning Center.
CAMPER INFORMATION:
Camper Name*

First NameLast Name
Birth Date*

MonthDayYear
Age of Camper as of June 1, 2023*
Grade (FALL 2023)*
Name of School (for Fall 2023)*
Parent/Guardian 1 Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Parent/Guardian 2 Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number

ADDITIONAL INFORMATION
Physician Name

First NameLast Name
Physician Phone Number

Area CodePhone Number
Dentist Name

First NameLast Name
Dentist Phone Number

Area CodePhone Number
Relevant Medical Concerns or General Information for Day Camp (ie: asthma, diabetes, compromised immune system, etc.)
Does your child take medication regularly?*

YesNo
If your child requires medication regularly, what is this medication and when is this medication administered?
Does this camp participant have allergies to bee or wasp stings? Please give details, like the severity of the allergy, if they carry an epipen, etc. in the space provided. *
Does this camp participant have any food allergies or sensitivities? Please give details in the space provided. *
Does this camp participant have any behavioral or medical conditions that we should know about? Please give details in the space provided. *
Has your child ever been asked to leave a summer or school-year educational or day care program because of their behavior? If so, please elaborate.*

Permissions Section
Please list the full name and the cell phone number for each of the people who have permission to pick up your child from camp. If you would like to add or remove from the list, you will have the chance to do so on the first day of camp when you submit the camper emergency card.*
We take photos throughout the week to make photo albums on the last day of each week. Some of these photos are so great we want to post them on social media. Do we have your permission to publicly post a photo of your child?*

YesNo
I give permission for my child, to wear sunscreen. I understand that I will provide sunscreen with my child’s name clearly printed on the bottle. The staff has my permission to reapply sunscreen as needed throughout the day and I will inform my child that they must allow us to put sunscreen on or they must apply it themselves when asked. I understand that there is a possibility that my child will get sunburned while in the care of Santa Cruz Learning Center.*

Clear
I give permission for Santa Cruz Learning Center staff members to transport children in camp-designated vehicles for daily off-site field trips and for emergency medical care.*

Clear
Santa Cruz Learning Center, LLC and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. *

Clear
I understand that NO FEES WILL BE REFUNDED or transferred unless a child is unable to participate due to an accident or illness per physician orders.*

Clear

Emergency Contact Form

gmail.com
Please go here and download the emergency card. Upload a scan or photo of your completed emergency form in the space below.

If you would rather, you can email it to santacruzlearningcenter@gmail.com
Browse Files
Upload a photo or a scan of your completed emergency form here. Cancelof
PAYMENT INFORMATION
Name of individual responsible for payment.

First NameLast Name
Relationship of responsible person to camper.
Email of responsible party.
example@example.com
We ask that you make a deposit to hold your spot in camp. Deposits are nonrefundable and will be forfeited should you decide not to attend SCLC Summer Camp.

You may choose to pay in full now. Please make your selection below.

Camp fees that are paid in full will be refunded up until June 1 minus a $25 fee.
prevnext( X )
Deposit to hold your spot$25.00
This is NON REFUNDABLE. We will contact you regarding billing for the rest of the summer camp fee. This is a deposit to hold your spot.

One Week of Summer Camp$200.00
This is for one week of summer camp with regular hours.

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Total $0.00
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Summer Camp Registration 2023

CAMPER INFORMATION:

Parent/Guardian 1 Information

Parent/Guardian 2 Information

ADDITIONAL INFORMATION

Camp Sessions

Permissions Section

Emergency Contact Form

PAYMENT INFORMATION