PPCS Summer Camp Registration Form

Registrations are processed on a first-come, first-served basis. Once all open spots are filled, any additional submissions will be placed on our waiting list. Upon completion of registration, you will receive an invoice through Procare for the $40 deposit per week to secure your child's spot. This deposit will go towards the weekly rate. Payment can be made through Procare using a credit card or bank draft, or by cash or checks made payable to Pleasant Plains Christian School.

Which week(s) are you registering for?*

June 24-28: Reading/Writing/PhonicsJuly 15-19: Math ConceptsAugust 5-9: Reading/Writing/Comprehension

Please select the student’s academic placement for the 2024-2025 school year*

How did you hear about us?*

First Name*

Last Name*

Gender*

FemaleMale

Birth Date*

MonthDayYear

Primary Language Spoken at Home*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Full Name*

First NameLast Name

Home

Area CodePhone Number

Cell*

Area CodePhone Number

Work

Area CodePhone Number

E-mail*

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

Full Name*

First NameLast Name

Home

Area CodePhone Number

Cell*

Area CodePhone Number

Work

Area CodePhone Number

E-mail

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

Who does the student live with? (Name and Relationship)

Are there any legal authority or parental restrictions regarding this Child?*

YesNo

If yes please, please explain:

Is there a court order or legal information we need to keep on file?*

YesNo

If yes please, please explain and provide legal documentation:

Does your child have any medical conditions?*

YesNo

If yes, please explain:

Does your child have any allergies?*

YesNo

If yes please list, including any drug allergies, food, plants, animals, or insect toxin:

Does the applicant have any physical, emotional, or behavioral disorders?*

YesNo

If yes, please explain:

Is there anything that we need to know about your child?

Full Name*

First NameLast Name

Relationship

Home

Area CodePhone Number

Cell

Area CodePhone Number

Work

Area CodePhone Number

Can this person pick up the student from school?*

YesNo

Full Name

First NameLast Name

Relationship

Home

Area CodePhone Number

Cell

Area CodePhone Number

Work

Area CodePhone Number

Can this person pick up the student from school?*

YesNo

Full Name*

First NameLast Name

Relationship

Home

Area CodePhone Number

Cell

Area CodePhone Number

Business

Area CodePhone Number

Can this person pick up the student from school?*

YesNo

Promotions are used by Pleasant Plains Christian School. I understand and agree that my child’s image may be used for such promotions and that Pleasant Plains Christian School is released from all liabilities.*

Yes, I agree.No, I do not agree.

Sick Policy:

If your child has a temperature of 100.4F or greater, or any symptom of a contagious disease or infection, you must make other childcare arrangements. In most cases, your child must remain at home at least twenty-four (24) hours and be temperature free for twenty-four (24) hours. Admittance is at the discretion of the Administration.

Medication Policy:

Pleasant Plains Christian School will only administer pre-measured prescription medications such as medicine for breathing apparatus or medicine for life threatening allergy. Pleasant Plains Christian School will not administer any medication without a “Permission to Administer Medication” form available on file.

Behavior Policy:

Pleasant Plains Christian School will always strive to develop a positive self-image. We recognize that children need clearly defined limits set in a non-threatening manner. We will encourage children to be self-directed and exhibit self-control. We will build individual esteem and avoid any shaming practices. We accomplish order and thus discipline through close supervision, gentle guidance, and redirection. Time-out is utilized in the classroom as a part of behavior management. We do not condone or employ corporal punishment as a means of discipline.

*BY SIGNING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND AGREE WITH ITS PROVISIONS AND ACCEPT RESPONSIBILITY FOR MY CHILD’S FINANCIAL ACCOUNT. I ALSO UNDERSTAND THAT ALL FEES THAT HAVE BEEN PAID ARE NON-REFUNDABLE.

*My signature below affirms that all information contained in this application is correct, complete, and honestly presented. I understand that withholding or misrepresenting information in this application may jeopardize my child’s admission or cause my student to be dropped from enrollment.

Signature

Parent Signature (Type your first and last name)

Summer Camp Registration Form

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian

Please read and sign: