Camp RB 2025 Reg Form

Registration Form - Camp Riverbend

To complete this form, you will need to have doctor's information including phone number and address. You also need TWO Emergency Contacts who are NOT the child's parents including phone numbers and one of their addresses.
CHOOSE YOUR CAMP SCHEDULE - Classes meet Monday through Thursday, 9:00 a.m. to 1:30 p.m.*

All 6 Weeks of Camp ($1,350)Session 1 Only - June 16-26 ($550)Session 2 Only - July 7-17 ($550)Session 3 Only - July 21-31 ($550)Both Sessions 1 & 2 ($1,000)Both Sessions 1 & 3 ($1,000)Both Sessions 2 & 3 ($1,000)
Child's Name*

First NameMiddle NameLast Name
Name that should be used at RBCS, if different than first name
Child's Date of Birth*

MonthDayYear
Date
How old is child today?*
Gender*
Friend Request - We cannot guarantee placement with a friend, but if birth dates and session choice are similar, we will try to accommodate.
Is child potty trained during the day?*
List any special problems that your child may have such as ALLERGIES, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medications prescribed for long-term continuous use, and any other information which caregivers should be aware of (or write N/A):*

Family Information
Mother's Name*

First NameLast Name
Mother's Email*
example@example.com
Mother's Cell Phone*

Area CodePhone Number
Father's Name*

First NameLast Name
Father's Email*
example@example.com
Father's Cell Phone*

Area CodePhone Number
Child's Main Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a Riverbend Church Member?*

Health Information
Name of Child's Doctor*
Doctor's Phone Number*

Area CodePhone Number
Doctor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Child's Immunization Records

Browse Files

Cancelof
In the event that we cannot be reached at the time of illness or accident, or the emergency is such that time does not permit such contact, we authorize Riverbend Christian School to take our child,Child's Full Name* , to the closest adequate medical facility where a licensed physician may treat the child.

We also authorize reasonable emergency steps necessary to preserve life or limbs of the child if otherwise qualified medical assistance is not available.

In the event of allergic reaction, we authorize the staff of Riverbend Christian School to administer Benadryl to our child.
Name of Parent Completing Form*

First NameLast Name
Signature*

Clear

Emergency Contacts

The child's parents CANNOT be listed as the child's Emergency Contacts. These are people who we can contact if there is an emergency and we cannot reach you. At least one of those contacts must have an address on file.
Non-Parent Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Phone*

Area CodePhone Number
Emergency Contact 1 Relation to Child*
Emergency Contact 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Non-Parent Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Phone*

Area CodePhone Number
Emergency Contact 2 Relation to Child*

Authorized Pick Up Persons

Parents DO NOT need to list themselves. If no one else will be picking up your child, please scroll down and click 'Next'. Please include a phone number and/or email address for each pick up person so that we can invite them to create a brightwheel account.
1 - Authorized Pick Up Person

First NameLast Name
1 - Authorized Pick Up Person Phone Number

Area CodePhone Number
1 - Authorized Pick Up Person Email
example@example.com
2 - Authorized Pick Up Person

First NameLast Name
2 - Pick Up Person Phone

Area CodePhone Number
2 - Authorized Pick Up Person Email
example@example.com
3 - Authorized Pick Up Person

First NameLast Name
3 - Authorized Pick Up Person Phone

Area CodePhone Number
3 - Authorized Pick Up Person Email
example@example.com
4 - Authorized Pick Up Person

First NameLast Name
4 - Authorized Pick Up Person Phone

Area CodePhone Number
4 - Authorized Pick Up Person Email
example@example.com
5 - Authorized Pick Up Person

First NameLast Name
5 - Authorized Pick Up Person Phone

Area CodePhone Number
5 - Authorized Pick Up Person Email
example@example.com

Acknowledgement of Policies
We agree that our child may attend Riverbend Christian School from 9:00 a.m. to 1:30 p.m. When the children is brought to school, he/she will be left in the presence of a staff member and will be released only to the parents or to those who the parents have provided written authorization to pick up the child. I acknowledge with my signature below.*

Clear
Date*

MonthDayYear
Date
BRIGHTWHEEL

I recognize that RBCS uses brightwheel for communication and agree to download the app so that I can stay informed about camp. I also recognize that I am responsible for checking my child in/out each day utilizing the app.

All fees are billed through brightwheel and parents can pay from their bank account FREE of charge. Credit cards result in additional fees.
Signature acknowledging use of brightwheel*

Clear
TUITION & FEES

I understand that half of all tuition for the sessions I have chosen are due at the time of enrollment. I understand that the balance is due by May 5, 2025.

In the event that I decide to withdraw my child for any or all sessions I have chosen, I agree to provide a written notice to the school office no later than May 5.

If I enroll my child for multiple sessions and decide to partially withdraw, I understand that the tuition due will be adjusted to the non-discounted tuition PLUS a $25 processing fee per session (e.g. Child is signed up for both sessions and $500 is paid toward the $1,000 tuition. If parent provides written notice by May 5 that the child will only attend Session 2, the balance owed will be $75, which is $550 tuition minus $500 deposit plus $25 processing fee).

If I choose to withdraw my child completely, I understand that a $50 processing fee per session will be non-refundable and kept by RBCS out of my tuition deposit.

If I decide to withdraw my child after May 5, I acknowledge that the deposit will not be refunded. I further understand that if I fail to pay the tuition balance by May 5, my child may be withdrawn automatically without any refund given for tuition deposits or a 10% late fee will be applied.

I understand that late fees will apply for late pick up should I fail to pick up my child by 1:30 p.m
Signature acknowledging Tuition & Fees Policies*

Clear
REQUIRED FORMS

I understand that additional paperwork is required to finalize my child's enrollment in Camp Riverbend.

I will provide:
- A record of my child's immunizations, if I did not attach them to this form
- Allergy Action Plan and Emergency Medication, if my child has an allergy
I understand that my child will not be permitted to attend until all have been received.

My child has been examined within the past 12 months by a health professional and is able to participate in a child care program.
Signature acknowledging additional required forms.*

Clear
SNACK & LUNCH POLICY

Parents are to send a nutritious snack and lunch each day. Riverbend Christian School is not responsible for its nutritional value or for meeting the child's daily food needs, however, nutritious foods are encouraged. Toddlers should bring finger foods cut into bite-size pieces and spill-proof cups.

Riverbend Christian School reserves the right to remove any foods they feel might be a choking hazard. For the safety of all children in our program, Riverbend Christian School is a NUT FREE environment and I agree not to bring nuts or nut products into the school buildings.
Signature acknowledging Snack & Lunch Policy*

Clear
PHOTO RELEASE

The Riverbend Christian School staff will take photos of the children during camp activities to share with the classroom families via the brightwheel app. These photos may also be used on the school website (www.rbcschool.com) and in marketing materials for the school, which may include Facebook (www.facebook.com/rbcschoolatx). When these photos are used for public viewing, at no time will children's names or other identifying information be included. I understand my child's photo may be posted in the classroom.

By signing below, I acknowledge the Photo Release and grant full permission for the staff of Riverbend Christian School to take and share photos of my child. I understand that I can choose to not have my child's photo shared outside of the school, such as marketing materials and web, and only share my child's photo within the classroom group by checking 'Opt Out of Public Sharing' below.
Check the box below if you are opting out of public sharing. By selecting the box, you are granting permission for your child's teacher to share your child's photo within the classroom and with classroom parents through brightwheel. However, your child's photo will not be used by school administration for slide shows, marketing, or on the internet when advertising the school's events or activities.

OPT OUT OF PUBLIC SHARING
Signature acknowledging Photo Release*

Clear
WATER PLAY POLICY

I understand that during Camp Riverbend there may be opportunities for my child to participate in water play that could include water tables, sprinklers, buckets of water or foam machine. I grant permission for my child to participate in water play activities at RBCS.

I understand that due to safety, RBCS does not allow wading pools, swimming pools or other water activities in which a lifejacket or swimming skills would be needed.
Signature to provide permission for Water Play*

Clear
HANDBOOK ACKNOWLEDGEMENT

I understand that the current RBCS handbook is available at www.rbcschool.com/camp. I have read and acknowledge all of the school policies within.
With my Signature I acknowledge and agree to all school policies.*

Clear
Date Completed*

MonthDayYear
Date
Riverbend Christian School, Inc. admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies and other school-administered programs.
Should be Empty:

Registration Form - Camp Riverbend

Family Information

Health Information

Emergency Contacts

Authorized Pick Up Persons

Acknowledgement of Policies