Winter Camp 2024-2025 Detailed Registration Form

Winter Camp 2024-2025 Registration

December 26–27 • December 30–January 3
Child Information

(one application for each child being registered)
Child's Name*

First NameLast Name
Gender

MaleFemale
Birth Date*

MonthDayYear
Age*
Shoe size*
for bowling, skating, etc.
Grade
Which grade will be completed June 2025?
My child attends the 2024–2025 school year at…*
Name of School
Does your child have special needs? (If yes, please call (703) 897-1100 to discuss the application process for children with special needs, so we may determine how we might best meet your child’s needs.)*

YesNo
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Family Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Parent/Guardian Information
Parent/Guardian 1*

First NameLast Name
Relationship*
E-mail*

Confirmation Emailexample@example.com
Cell Number*
Work Number*
Parent/Guardian 2

First NameLast Name
Relationship
Email
Cell Number
Work Number

Winter Camp 2024-2025 Rates

Age	One-Time Registration	All 6 Days	Optional Per-Day Price
4*	$75	$280	$55
5–8	$75	$200	$45
9-13	$75	$180	$45

*Before and After Care is included in the registration for children age 4.

Select which days your child will attend Winter Camp*

All 6 DaysDecember 26December 27December 30December 31January 2January 3
Before & After Care Rates
- Before Care: $20/day
- After Care: $20/day
- Before & After Care: $25/day
Before Care is 6:00–8:30am. After Care is 4:00–6:30pm.

*Before and After Care is included in the registration for children age 4.
Before Care Needed:*

YesNo
After Care Needed:*

YesNo
Before & After Care Needed:*

YesNo
Informed Consent and Acknowledgement

Upon completion of the registration process, a parent portal will be set up for me so I can see my account and make credit card payments. I may also pay by money order made payable to “Cornerstone Christian Academy.” Personal checks and/or cash are not accepted.

The one-time registration fee for my child to attend Cornerstone Summer Camp is non-refundable.

I understand that I will be charged for weeks that I sign up for, and that all schedule changes must be made in advanced, in writing, to the school office. I am responsible for each full week’s tuition if I do not submit written schedule changes in advance. I also understand I will be responsible to pay for the weeks I have committed to.

I understand that this application is not complete without my signature and will be returned to me if I have not completed all spaces and signed below.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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Winter Camp 2024-2025 Registration

Child Information

Before & After Care Rates