Grace Day School Kids Kamp Registration Form 2025

Grace Day School Kids Kamp Registration Form 2025
Grace Day School

10101 Walnut Hill Lane

Dallas, Texas 75238

214-348-9691

director@gracedayschool.net
Name*

Childs First nameChilds Middle NameChilds Last Name
Child's Nickname Preferred First Name
Date of Birth*

MonthDayYear
Date
Child's Gender*

MaleFemale
Parent's Telephone Number*
Child's Address, City Zip*
Parents Email Address*
example@example.com
Session: (Be sure to select both boxes if you want both sessions!)*

Session 1, June 2-4, 9-11, 16-18Session 2, July 7-9, 14-16, 21-23
With whom does the child reside? If applicable, please attach a copy of court documentation of child's permanent residence and custodial rights.*

MotherFatherOther
Court Documentation of Child's Permanent Residence & Custodial Rights (If Applicable)

Cancelof
Family Status:*

Currently Enrolled FamilyNew FamilyAlumni Family (Have an older child that attended Grace/Bethany in the past)Grace Church Member

Parent & Guardian Information: (DRIVERS LICENSE NUMBERS ARE MANDATORY FOR ALL PARENTS/GUARDIANS LISTED!)*

	Name	Drivers License #	Cell Phone	Work #	Occupation
Mother
Father
Guardian

I authorize the Center to allow my child to leave the Center ONLY with the following persons (besides parents). In an emergency, if a parent cannot be reached, the Center will contact the following in the order in which they are listed: (DRIVERS LICENSE NUMBERS ARE MANDATORY FOR ALL PERSONS LISTED!)

	Full Name	Phone Number	Drivers License #
Person 1
Person 2
Person 3

I hereby do/do not give consent for my child to participate in water activities:*

I Give ConsentI Do Not Give Consent
If you give consent for water activity participation, please select all that applies:

Sprinkler PlayWater Table Play
Grace Day School has my permission to photograph/videotape my child's image for uses checked below:

AllNametagsScrapbooksClassroom ProjectsNewspaper ArticlesGifts to Be Sent HomePamphletsVideotapesGrace Day School WebsiteGrace Day School Facebook
Special Requests / Notes: We will do our best to accommodate any special requests listed here. All requests must be submitted before the registration period ends.
Parent Signature*

Clear
Today's Date*

MonthDayYear
Date
I understand that the Center does NOT provide lunch and that I am responsible for the nutritional value as described in Minimum Standards and for meeting my child's daily food needs.

I understand that it is my responsibility to promptly update any information included on any Center forms.

This registration form, along with payment for the summer session fees, will ensure a place for your child in the program. Program fees are due before each summer session begins and are non-refundable.

Tuition for one session is $400. Tuition for both sessions is $760.

ENROLLMENT INFORMATION SHEET
My child is currently enrolled at Grace Day School for the last school year and has an existing student file. (You do not have to complete the rest of this form, but signature is required here)*

Yes, My Child Attended Grace Day School for the 2024-25 School Year (You May Sign, Date & Submit Form)No, My Child Does Not Attend Grace Day School (You must Complete the Rest of This Form)
Current Families Signature: Parent or Legal Guardian

Clear
Today's Date

MonthDayYear
Date
Families Not Currently Enrolled, Please Complete the Following. You MUST Submit With A Physician-Signed Copy of Your Child's Shot Records
If medical diagnosis and treatment and / or immunization and TB testing conflict your religious beliefs, you must sign an affidavit to that effect and submit with this form.

If immunization and / or TB testing would be injurious to your child or family, you must obtain a certificate (signed by a heath care professional) to that effect and submit with this form.
My Child Is Exempt from Immunizations: (Document Uploaded)

YesNo
Affidavit or Signed Healthcare Provider Document Upload HERE:

Cancelof
Allergies & Pre-Existing Conditions:
List allergies, existing illness, previous serious illness & injuries during the past 12 months as well as medication prescribed for long-term continuous use of which staff should be aware to properly care for your child: (Please enter NA if none exist)
Pediatrician:
Pediatrician Phone #:
Pediatrician's Address, City, State & Zip Code:
Other Emergency Contact: Name/Number/Relationship
Insurance Provider:
Policy/Group Numbers:
Date of Last Tetanus Booster

MonthDayYear
Date
Upload Child's Shot Records HERE:

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Discipline Policy

Discipline must be: Individualized and consistent for each child; Appropriate to the child's level of understanding; and directed toward teaching the child acceptable behavior and self-control. A caregiver may only use positive methods of discipline and guidance that encourage self-esteem, self-control, and self- direction, which include at least the following: Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior; Reminding a child of behavior expectations daily by using clear, positive statements; Redirecting behavior using positive statements; and using brief supervised separation or time out from the group, when appropriate for the child's age and development, which is limited to no more than one minute per year of the child's age. There must be no harsh, cruel, or unusual treatment of any child. The following types of discipline & guidance are prohibited: Corporal punishment or threats of corporal punishment; Punishment associated with food, naps, or toilet training; Pinching, shaking, or biting a child; Hitting a child with a hand or instrument; Putting anything in or on a child's mouth; Humiliating, ridiculing, rejecting, or yelling at a child; Subjecting a child to harsh, abusive, or profane language; Placing a child in a locked or dark room, bathroom, or closet with the door closed; and Requiring a child to remain silent or inactive for inappropriately long periods of time for the child's age.

Insurance Verification Notification

Please be informed that Grace Day School maintains liability insurance coverage in excess of $300,000.00 amount for each occurrence of negligence that is required by Section 42.0491 of the Human Resources Code for the State. The center is covered under Policy No.MP000903010001700 for The Day School at Grace Church Lake Highlands through Mesa Underwriters Specialty Insurance Co. If you have any questions concerning this insurance, please notify the director.
Is your child potty trained?
Does your child nap?
Is there anything we should know to make your child's day better?
Signature of Parent or Legal Guardian

Clear
Today's Date

MonthDayYear
Date
Submission Date & Time:

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

Grace Day School Kids Kamp Registration Form 2025

ENROLLMENT INFORMATION SHEET

Families Not Currently Enrolled, Please Complete the Following. You MUST Submit With A Physician-Signed Copy of Your Child's Shot Records

Allergies & Pre-Existing Conditions: