O.D. Epps Youth Program Registration Form

O.D. Epps Youth Program Registration

820 E. Wintergreen Rd. * Cedar Hill, TX 75104 * 972-230-4477
PARTICIPANTS
All youth of the Community Missionary Baptist Church, Nova Academy, and as well those from the community, are welcome to attend, but we don't provide transportation.

·         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: $25.00 per household - (due at time of registration)

Weekly Payment: $75.00 per child - Before OR After (due on Mon – No Later than 5pm) $100.00 per child - Before AND After (due on Mon – No Later than 5pm)
$130.00 or $180.00 two kids - (same household) $180.00 or $240.00 three kids - (same household)

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 CHECKS – No Partial Payments Will Be Accepted

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

IMPORTANT INFORMATION - NOT FOR TAX PURPOSES

O.D. Epps Youth Program is not a day care operation nor is it an extension of the Community Missionary Baptist Church. Therefore, the Youth Program does not have a tax identification number for income tax purposes. As a result, the YP 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 YP WILL NOT issue a contribution statement reflecting payments made.

However, the YP 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.
Signature

Clear

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 Youth Program or designated administrator to dispense over-the-counter medication to my child _________________________________ during the 2023 youth 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 Youth Program is prohibited from administering any medication without a completed and signed parental consent form.

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 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.:

O.D. Epps Youth Program Registration