2024 Summer Camp Form

2024 NPC Christian Preschool Summer Camp Registration Form
Narberth Presbyterian Church Christian Preschool is pleased to offer summer camp for 2024! Here are the details:
- Camp will run for 6 weeks beginning Monday, June 24 and ending August 1, 2023.
- Camp will be Monday thru Thursday, except for Thursday, July 4 when camp will be closed.
- We will offer 3 camp groups:
  - Mini campers: 18 months - 2.5 years
  - Junior campers: Threes/Young 4s (toilet trained required)
  - Senior Campers: Older 4s/Rising Kindergarteners (toilet trained required)
- Camp will meet 9am – 1pm for all groups.
- Campers should pack a water bottle, a nut-free snack and lunch each day.
- Camp activities will include outdoor play, art club, music, sports, STEM activities and more!
- There is a requirement to select at least 3 weeks, and if you choose all 6 weeks, there is a $50 discount.
- Tuition:
  - Mini Campers: $170/week
  - Junior Campers: $160/week
  - Senior Campers: $160/week
- There is a $50 registration fee to hold your spot.
- Current families will be invoiced over Brightwheel. New families should mail the registration fee to NPC Christian Preschool, 205 Grayling Avenue, Narberth, PA 19072 (Attn: Karin Waller, Bookkeeper)
- Each child must have a current health form (completed in the last 12 months) on file. You can access the health form HERE.
- Summer camp tuition is due in full by June 1, 2024.

Child's Information
Child Name*

First NameLast Name
Nickname, if applicable
Date of Birth *

MonthDayYear
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent # 1 Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent # 2 Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Enrollment

(Select One Option)
Mini Campers: 18months by the start of camp to ~ 2.5 years (toilet-trained not required)
Junior Campers: 3 year olds and younger 4s (toilet-trained required)
Senior Campers: Older 4s and rising Kindergartners (toilet-trained required)
Please select the weeks you would like your child to attend summer camp (3 week minimum in order to enroll).

I would like my child to attend all 6 weeks and receive a $50 discount.Week 1 June 24 - June 27Week 2 July 1 - 3 *Note: Camp does not meet on Thursday, July 4.Week 3 July 8 - 11Week 4 July 15 - 18Week 5 July 22 - 25Week 6 July 29 - August 1
Please select a payment method
Emergency Contacts
Parents are the first emergency contacts. List the name of at least three additional people who can be contacted in the event of an emergency or illness if you cannot be reached. These individuals will also be approved pickups. Any person listed should be able to assist in contacting you, able to take responsibility for the child in case the parent/guardian cannot be contacted, and should be at least 18 years of age with proper identification.
Emergency Contact #1*

First & Last NameRelationship to child
Phone Number*

Area CodePhone Number
Emergency Contact #2*

First & Last NameRelationship to Child
Phone Number*

Area CodePhone Number
Emergency Contact # 3*

First & Last NameRelationship to Child
Phone Number*

Area CodePhone Number

Medical/Health Information
Name of Physician or Clinic/Hospital*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Insurance Provider *
Insurance Policy #*
Does your child have any Special Disabilities?*

YesNo
Does your child have any allergies?*

YesNo
Does your child have a special health or medical condition?*

YesNo
If you answered yes to the question above, please provide a brief summary of their condition.
First Aid and Emergency Medical Care Consent
Child's Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
My full signature below authorize staff in the program who are trained in the basics of first aid to give my child first aid when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. I also understand that all incidents will be recorded in an incident/medication log. However, if I cannot be reached, I hereby authorize to transport my child to the nearest medical care facility and to secure necessary medical treatment for my child. I understand that I assume all financial responsibility for any treatment or injuries sustained by my child while he/she is in the program.
Full signature below to consent to first aid and emergency medical care for my child*

Clear
Is your child currently using any medication? If yes please explain. If no type "N/A'.*
I understand that it is my responsibility to provide an up-to-date health form (included at the beginning of this form) for my child. This form must include my child's up-to-date vaccinations, the date of their last physical and a signature or e-signature from their doctor.**

Yes
Is there anything else about your child that would be helpful for our summer camp staff to know?

Photograph/Media release authorization on behalf of Christian Preschool
YES, I do give permission to have my child appear in any media coverage (t.v., newspaper articles, photographs, website, social media) on behalf of Christian Preschool.*

Yes
Walking Field Trips & Water Play Permission
YES, I do give permission to allow my child to attend walking field trips and to participate in outdoor activities such as water day. I understand that it is my responsibility to send my child with all required items for special activities.*

Yes
Please note any special accommodations for your child.

Parent/Guardian Agreement

Please review the following policies and initial each.
General Policies

I am enrolling my child in 2023 Summer Camp at Christian Preschool.
I understand that there is an application fee of $50.
I understand there is a tuition fee which is due by June 1, 2023 date via Brightwheel or by check. I understand that I am responsible for processing fees occured by Brightwheel for online transactions.
I understand that NPC Preschool will be providing camp from the hours of 9:00 AM - 1:00 PM.
I understand that my child will not be dismissed from the program without being picked up by a parent-designated adult.
I understand there will be a $15 fee will be added every 15 mins for any late pick-ups.
I understand that if a medical emergency arises, program staff will attempt to contact parents or the emergency contact that I have indicated. It is the parent’s responsibility to notify the staff if this information changes. If immediate medical attention is necessary, an ambulance or emergency vehicle may take my child to the hospital of their choice.
In cases of illness, I understand that my child may not be permitted to attend the program. If staff feels that a child has a contagious disease, he/she may not return to the program without a doctor’s note.
In order for my child to be considered for this program I understand that I must complete all enrollment paperwork and health assessments.
I understand that the Christian Preschool Summer Camp program is faith-based (Christian).
I have received complete program information (handbook) at the time of enrollment (PA Code 3270.121, 3280.121, 3290.121)
I agree to update the emergency contact and parental agreement when changes occur or every 6 months at a minimum. (PA Code 3270.124, 3280124., 3290.124)
I have read and understand the General Policies (Full signature)*

Clear
Non-Discrimination in Services
SUBJECT: Nondiscrimination in Services

TO: Parents/Guardians

FROM: Virginia Davis, Director

Admissions, the provisions of services and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age or sex.
Program Services shall be made accessible to eligible persons with disabilities through the most practical and economically feasible methods available. These methods include, but are not limited to, equipment redesign, the provision of aides and the use of alternative service delivery locations. Structural modifications shall be considered only as a last resort among available methods.
Any individual/client/patient/student (and/or their guardian) who believes they have been discriminated against, may file a complaint of discrimination with:

Narberth Presbyterian Church Christian Preschool
205 Grayling Ave
Narberth, PA 19072

Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity
Room 225, Health & Welfare Building P.O. Box 2675
Harrisburg, PA 17105

Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity Southeast Regional Office 110 N. 8th Street, Suite 501 Philadelphia, PA 19107

PA Human Relations Commission
Harrisburg Regional Office
333 Market Street, 8th Floor Harrisburg, PA 17101

U.S. Department of Health and Human Services
Office for Civil Rights
Suite 372, Public Ledger Building 150 South Independence Mall West
Philadelphia, PA 19106-9111
I have read and understand the nondiscrimination in services notice (Full signature) *

Clear
Dismissal, Discipline, and Discharge Policy
Children are not permitted to arrive alone and must be escorted by an adult.
Children are only permitted to be signed out by an approved pickup over the age of 18.
The fee for late pick up is $15 per 15 minute interval. Excessive lateness will be reviewed.
Children are not permitted to bring any toys from home.
A child who displays chronically disruptive behavior may be suspended or discharged at the discretion of the camp supervisors.
Unacceptable Behavior of the child:
Spitting, biting, or hitting
Inflicting physical harm on other children or staff
Inappropriate language or drawings
Using profanities or obscenities
Ridiculing or bullying other children
Taking other children’s belongings
Destruction of school or personal property
Ignoring or disobeying the rules during the program times
I have read and understand the Dismissal, Discipline, and Discharge Policy (full signature) *

Clear
Sign Document (full signature)*

Clear
Please print the full name of the person completing this form.
Date Signed*
Should be Empty:

2024 NPC Christian Preschool Summer Camp Registration Form

Child's Information

Enrollment

Emergency Contacts

Medical/Health Information

First Aid and Emergency Medical Care Consent

Photograph/Media release authorization on behalf of Christian Preschool

Walking Field Trips & Water Play Permission

Parent/Guardian Agreement

Non-Discrimination in Services

Dismissal, Discipline, and Discharge Policy