AAOC Camps For Youth Development - The E Program Aftercare Application

AAOC Camps For Youth Development - The E Program Fall 2024 Application

Thank you for choosing AAOC Camps! Please complete the application in its entirety. If you have multiple children, please complete multiple applications. Should you have any questions, please do not hesitate to contact us by email (aaoccommunication@gmail.com) or by phone at 615.289.2716. Please note, a non-refundable application fee of $35 must be paid to confirm registration. Thank you!
To submit your registration fee, please visit aaoccamps.org/fees
Please select a service:*

Before Care onlyAftercare onlyBOTH Before & Aftercare
Enrollment Date*

MonthDayYear
Date
Parent's Name*

First NameLast Name
Parent's Name

First NameLast Name
Phone Number*
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Email
example@example.com
In the event of a medical emergency, please contact:*
In the event of a behavioral emergency, please contact:*
Emergency Contact Name*

First NameLast Name
Emergency Phone Number*
Please enter a valid phone number.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Youth T-Shirt Size (XS, S, M, L, XL, 2X, etc.)*
Name of last school attended*
Grade entering*
School currently attending*
PARENT AUTHORIZATION

*Your signature must be received before your child is admitted into the program.
I approve this registration and certify that my child is capable of such an experience. I grant permission for my child to be transported from the school listed on this application to AAOC located at 2620 Clarksville Pike, Nashville, TN 37208. AAOC Site Director has permission to contact my child's teacher(s) regarding his/her homework, grades and tutoring. In the event of an accident or illness, AAOC will seek to secure immediate emergency medical treatment. Prudent attempts will be made to notify the parents immediately. I understand the related expenses for this medical attention will be my responsibility. AAOC is not responsible for lost, stolen or damaged personal articles. The attached health history is correct and complete to the best of my ability and knowledge, and the person herein described has my permission to engage in all camp activities except those noted on the health history form.
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
501(C)(3) NONPROFIT ORGANIZATION PARTNERSHIP WITH PARENT & FAMILY INFORMATION, FALL 2024

*Please initial next to each space. Your initials must be received before your child is admitted into the program.
1. My child has permission to participate in all AAOC E-Program activities, understanding that my weekly payment of $55.00 (before care), $75.00 (aftercare) or $120.00 (both before and aftercare) does not include field trips. I also understand that I will be charged a non-refundable registration fee of $35.00.*
2. I hereby give consent to AAOC Camps, its affiliates, media outlets, community organizations, and/or third parties providing service to AAOC Camps to take and use images (photographs or video) or sound recordings of me and/my child/children for whom I'm giving consent, and to disclose such information in any of AAOC Camps' and/or third party media outlet, including radio, television, internet, social media, or print. I understand that the intended use of such images and information may be for advertising, marketing, fundraising, or promotional purposes of AAOC Camps.*
3. I understand and agree that all children enrolled in the program are expected to follow the rules established by the staff, for the purpose of safety and smooth operation of the program. If a disciplinary problem occurs, the Site Director or her Designee will contact me. The discipline procedures are as follows: 1. Verbal Warning 2. Five Minutes in “Time Out” (Away from the Group) 3.Site Director notified/Conference with Child and Site Assistant 4. Conference with Parents 5. Dismissal from the Camp ****Immediate Dismissal will occur for the following: 1. Harming another child or staff person 2.Stealing 3. Damaging or destroying property 4. Using foul or profane language 5. Being totally disruptive and uncontrollable in the group.*
4. I understand that The E-Program is in a community environment and its classes and lessons are all family-oriented and academically based.*
5. I understand that weekly fees must be paid on Mondays in advance for the following week. A late fee of $10.00 will be assessed beginning Wednesday if payment is not received and every week following until all payments are collected. If payment has not been received by the close of business on Wednesday to include the late fee, your child will not be admitted back into the program until payments have been made satisfactory. I understand a holding fee of $25.00 per child will be due for each week my child/children are absent and AAOC is open during school breaks: Fall Break, Christmas Break, Spring Break, all breaks etc.*
6. I understand that if my child is registered for weekly attendance and they attend one or two days, I will still be responsible for the weekly fee amount.*
7. I understand that I or my child may be asked to complete a survey providing information regarding the program for evaluation purposes.*
8. I understand and agree that any checks returned, regardless of the reason will be assessed a $35.00 service charge and late fees.*
9. I understand that The E-Program concludes its day at 5:30pm. I agree to pay a late fee of $2.00 per minute for any time after 5:30pm. I also understand that this fee must be paid at the time of my arrival to pick-up my child.*
10. I agree to hold The E-Program blameless in the event of accident, sickness or injury. I, the parent/legal guardian will be the sole responsible party.*
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
CONSENT FOR RELEASE
I authorize AAOC Camps for Youth Development (AAOC Camp, Men of Honour Camp, The E Program) to release my child/children to the following adult(s) listed below. Please note, each adult must provide a proper form of identification for your child/children to be released.
Child's Name*

First NameLast Name
1. Name, Address & Phone Number*
2. Name, Address & Phone Number
3. Name, Address & Phone Number
4. Name, Address & Phone Number
5. Name, Address & Phone Number
Parent Signature*

Powered by Jotform SignClear
501(C)(3) NONPROFIT ORGANIZATION HEALTH INFORMATION
Child's Name*

First NameLast Name
Social Security Number*
Does your child have an Individualized Education Plan (IEP)?*

YesNoIf the answer is yes, please share the IEP
Insurance Information

Please note: AAOC Camps does not carry any accident or sickness insurance for participants
Is the child covered by family medical/hospital insurance?*

YesNo
If you answered yes, please provide the following. If you answered no, please type "N/A":
Carrier*
Carrier's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insured Party's Name*
Child's Relationship to this Party*
Please supply a copy of your insurance card for our records.

A photo copy is required for your child's admission into the program.
Cancelof
Physician's Name*

First NameLast Name
Physician's Phone Number*
Please enter a valid phone number.
Choice of Hospital*
Please list any allergies, medical conditions, or other conditions to be considered that we should be aware of. If none, please type "N/A"*
Are there any special instructions from you or the child's physician regarding treatment during camp/after/before care hours?*

YesNo
If your answer is yes, please list the information here. If your answer is no, please type "N/A"*
If your child is unable to participate in the food program and cannot drink milk or cannot consume certain foods, please provide verification from your child's doctor.
Routine Medications: Please list ALL prescription medications. Keep all medication in its original packaging that identifies the prescribing physician, the name of the medication, the dosage and frequency of administration. If none, please type "N/A"*
Is there anything else you'd like us to know?
How did you hear about us?
Should be Empty:

AAOC Camps For Youth Development - The E Program Fall 2024 Application

PARENT AUTHORIZATION

501(C)(3) NONPROFIT ORGANIZATION PARTNERSHIP WITH PARENT & FAMILY INFORMATION, FALL 2024

CONSENT FOR RELEASE

501(C)(3) NONPROFIT ORGANIZATION HEALTH INFORMATION

Insurance Information