2026 Paseo Verde Summer Camp Registration

2026 PASEO VERDE SUMMER CAMP REGISTRATION FORM

This registration form is for childcare, NOT for summer school.

Tuesday May 26 - Friday July 24, 2026

(LOCATIONS AND DATES SUBJECT TO CHANGE)

Before starting this form, please have a copy of your child's
immunization records available to upload or to take a picture. Previous submissions are NOT on file and a new copy is REQUIRED to complete this registration.

The City of Peoria is currently taking registrations for 2026 Summer Camp (childcare). This program is licensed through the Department of Health Services, and is available from 6:00AM to 6:00PM Monday - Friday. Please be aware that care for June 19 and July 3rd will be available ONLY at these schools:

Cheyenne Elementary: 11803 N 87th Ave
Sunset Heights Elementary: 9687 W Adam Ave

Weekly attendance fees for the program will be automatically charged every Monday at the start of each week based on the scheduled attendance you select. A $30.00 non-refundable registration fee per child will be charged for NEW childcare particpants and $10.00 per child for CURRENT 2025-26 AMPM particpants or returning 2025 Summer Camp participants. This fee will be processed when your registration is processed by our staff. We do NOT offer multi-child discounts.

Your finance information is REQUIRED for automatic payment and must be added to your Peoria Recreation account within 12 hours after submitting this form. Directions on how to add your finance information are listed at the end of this registration. Please take a picture of these directions or write them down before submitting this registration form.

Administration business hours are Monday through Thursday, 7AM to 6PM except holidays. CLOSED on Fridays. Please call 623-773-7139 or 623-773-7505 with any questions regarding registration or pricing.

Program capacity at each school is dependent on available space and staffing.

What grade is your child ENTERING IN THE FALL (Aug 2026)?

Summer Camp Site your child will attend:

*PLEASE NOTE: The City of Peoria SUMMER CAMP (childcare) program is NOT the same program as PUSD Summer School (education). IF your child has been invited to attend Summer School through the Peoria Unified School District, you must submit an online schedule change form no later than 12:00PM, Friday May 15th stating on the change form what your child's new summer camp (childcare) attendance schedule will be due to attending Summer School. Your child must be invited by their teacher/school at your child's school to participate in Summer School. Proof may be required that your child is attending Summer School (extended education). The City of Peoria does not provide transportation to summer school.

Attendance Schedule for Summer Camp (childcare)

Please check the days needed for childcare each week. You must choose all days/weeks your child will attend.
No credit back for sick/missed days or early pick-ups.

Drop In Schedule is NOT an option.

RATES: Weekly attendance fees are a Flat Rate, NOT a daily rate.

Part Time Option: 1-3 days: $115.00, whether you select 1,2 or 3 days a week.

Full Time Option: 4-5 days: $185.00, whether you select 4 or 5 days a week.

UNSCHEDULED Days of attendance: $50.00 per day, per child. If you select Mon, Tues & Wed on the registration form and attend Mon, Tuesday,Wednesday & Friday, you will be charged for your (3) regular scheduled days of part-time care PLUS $50 for attending Friday, an unscheduled day of attendance.

Week of May 25: Part Time 1-3 days = $115; Full Time 4-5 days = $185; NO camp on Monday, May 25

Week of June 1

Week of June 8

Week of June 15

Which site will your child be attending on June 19?

Week of June 22

Week of June 29

Which site will your child attend on July 3?

Week of July 6

Week of July 13

Week of July 20: (FINAL week of Camp)

Before starting this portion of the form, please have a copy of your child's immunization records available to upload (PDF attachment or you can take a picture). Previous year's submission is NOT on file and a new copy is REQUIRED to complete this registraiton.

Child's Name

First NameLast Name

Child's Date of Birth:

Date

First day child will start the program:

Date

Sex:

Address

Street Address

Apt # (if aapplicable)

CityState / Province

Postal / Zip Code

Mother or Guardian Name If none, type N/A

First NameLast Name

Address (if none for mother, type N/A in all required fields)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Guardian Telephone Number:

If none for mother type N/A

Guardian Email

example@example.com

Father or Guardian Name (If none, please type N/A)

First NameLast Name

Address (if none for father, type N/A in all required fields)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Guardian Phone Number:

Email Address:

If none for father type N/A

I authorize the following individuals to collect my child from the facility in case of emergency or if I cannot be contacted: (Pursuant to R9-5-304.B, at least two contact persons are required other than mother and father and cannot duplicate.

First Contact Name (first and last name, other than mother or father):

First Contact Telephone Number:

Second Contact Name (first and last name, other than mother or father):

Second Contact Telephone Number:

Third Contact Name (first and last name, other than mother or father):

Third Contact Telephone Number:

Fourth Contact Name (first and last name, other than mother or father):

Fourth Contact Telephone Number:

If Medical care is necessary, call:

*A Health Care Provider is a physician, physician assistant or registered nurse practitioner.

Health Care Provider Name: (not insurance company)

Health Care Contact Telephone Number:

In case of injury or sudden illness,

I request that this individual be called first (first and last name):

The following individual(s) may NOT remove my child from the facility:

Name(s):

Custody papers have been provided and are on file at the facility. (If yes, you must upload a copy with your shot records).

Telephone Authorization Code (optional):

For information regarding current immunization requirements go to: www.azdhs.gov/phs/immun/index.htm or contact the Arizona Immunization Program Office at (602)364-3630.

One of these items must also be provided:

Is child allergic to food or other substances?

If yes, describe symptoms, name foods or substances to be avoided, and the procedure to follow if reaction occurs:

Is child usually susceptible to infections and if so, what precautions need to be taken?

If yes, list precautions:

Is child subject to convulsions and what should be our procedure if one occurs?

If yes, specify procedure:

Is there any physical condition that we should be aware of and what precautions should be taken (heart trouble, foot problem, hearing impairment, hernia, etc)?

If yes, list precautions:

Additional comments:

Other special instructions:

This Emergency Information and Immunization Record Information is accurate and complete and was provided by:

Parent/Guardian PRINTED Name:

Signature: (use your mouse or finger to sign)

DATE Submitted:

DateHourMinutesAM/PM Option

How would you like to submit your child's shot records and/or custody papers? (Shot records are required) - We do NOT have any immunization records on file for previous years. Failure to provide the required documentation will result in the denial of the registration.

Upload shot records or any necessary custody papers from your computer. Document MUST be an immunization record of the child listed n this registration.

Browse Files

--OR--- Take photo of shot records or any necessary custody papers from your phone or tablet. Picture MUST be the immunization record of the child listed in this registration.

Does your child receive DES childcare assistance? If yes, it is the parent/guardian's responsibility to ensure the billing department has received your DES authorization PRIOR to registering for the Summer Camp Program. Your account will be charged full fees until DES approval has been received by the billing department. Child must be must be approved at the Summer Camp site chosen. Please call 623-773-7505 or 623-773-7139 to verify DES approval has been received.

Does your child need any special accommodations? Modification services for participants that need additional support and guidance is available for those that qualify. Applications and supported documentation will be reviewed within 48 hours of receipt and are not guaranteed. For more information, please contact leslie.king@peoriaaz.gov or call 623-773-7108.
Modification Form

About Me Questionnaire

This confidential information will be used to help your child care provider support the growth and development of your child while creating a safe, stable and healthy environment for all children. By providing complete information about your child, you will be assisting us in creating a positive experience for your child while in our care. Confidentiality is a vital component in the child care setting. Therefore, we will only share this questionnaire with the child care director, owner and your child's primary teacher unless approved by a parent/guardian.

Instructions: A parent/guardian must complete the Best of Care form, and it must be on file at the program on/or before your child’s first day of attendance. Additionally, the questionnaire should be updated when significant changes occur in the child's care or annually.

In order to better service citizens who require modification, Please complete the Inclusion Service Form. This needs to be 1-2 weeks prior to the first day of attendance.

City of Peoria Youth Program Leadership may reach out to you prior to admission to follow up on response provided below.

What is your preferred method of communication?

Has your child previously attended child care?

If yes, what type of setting (s) was your child in? (family child care, group care, etc)

What did you most like about your child's previous child care setting?

What did you like the least?

What is important to you about your child's care?

Who is important to your child?

Does your child prefer to play alone or with other children?

Does your child have a favorite toy or comfort object?

If yes, what?

What is your child's current sleep schedule?

Does your child fall asleep easily?

What is your child's mood like upon awakening?

What does your child like?

What does your child dislike?

Special things you say or do to comfort your child are:

How do you know when your child is:

Happy:

Sad:

Mad:

Tired:

Other:

How does your child react when:

Something unexpected happens:

Something happens they don't like:

They are scared:

Other:

Does your child have any health issues?

If "Yes", please explain:

Has anything happened recently in your child's life that might affect them?

If "Yes", please explain:

Is there anything else you would like to share about your child to help us create a positive environment and relationship with your child?

Is your child in foster care?

If yes, please list the Case Manager's name and contact information:

I (as parent/guardian) decline to complete the About Me Questionnaire. (type initials ONLY if you wish to decline - otherwise, leave blank)

I give permission for my child to be video taped or photographed by the City of Peoria employees or established area media for the free use of my child's name and picture for site activities or should they appear in broadcast, newspapers or any brochure, etc.

I understand that sunscreen must be applied by a parent or guardian

I have read and agree to abide by the City of Peoria Waiver

I have read and agree to abide by the AMPM/Summer Camp Parent Handbook

City of Peoria AMPM Youth Program Waiver
Release, and Assumption of Risk Form

On behalf of myself, my household members, and as parent and lawful guardian of my minor child, I hereby give permission for my child to receive childcare services at the City of Peoria Summer Camp program. My child and I are familiar with, and knowingly and voluntarily accept, any and all risks associated with childcare on a school campus. I acknowledge that my child’s participation in this program is voluntary and is not part of any regular school curriculum.

I specifically assume all risks and hazards associated with my child’s participation in the City of Peoria Summer Camp program. I understand that my child will be associating with staff and other children and may be exposed to viruses and diseases, through my child’s participation in the City of Peoria Summer Camp program. I understand and voluntarily assume the risk that my child may acquire a virus or disease and subsequently be transmitted from my child to me, my family, and members of my household.

I certify that my child is in good health, has no fever, and has no current issues that make it unsafe for my child to participate in the City of Peoria Summer Camp program, which will not have a medical professional on-site. I will notify the school and not send my child to the City of Peoria Summer Camp program if my child develops a fever or illness.

To the fullest extent permitted by law, I hereby agree to waive, release, and discharge any and all claims, causes of action, damages, and rights of any kind, including serious injury or death, against: the City of Peoria, the school where my child attends, the Peoria Unified School District, its insurers, the district’s governing board, and all of their respective employees, agents, representatives, and volunteers (the “Released Parties”) arising from or relating in any way to my child’s participation in the City of Peoria Summer Camp program.

Parent/Guardian Signature

To Add your Finance Information: Be sure you are using a desktop or laptop computer and Google Chrome as your internet browser. After you click on SUBMIT below, you MUST log into your City of Peoria Recreation account and input your required finance information. To do this, you will log into your recreation account, click the primary account holder (parent or guardian only, NOT the child), then scroll down and look for the FINANCE INFO line. Click on the NEW button. After the screen opens, be sure you check the box next to the Default button at the top left. Complete the information and click Save.

Failure to submit your financial information within 12 hours WILL result in the removal from the Summer Camp Program.

What are the LAST FOUR numbers of the debit/credit card or checking account number that you will be using for this program? (This must match the finance information you enter on your Peoria Recreation account)

This will be used to make sure staff sets up the CORRECT finance information for your payments. If the information listed here does not match the finance information you list on your Peoria Recreation account, THIS REGISTRATION WILL NOT BE PROCESSED. An entry here does NOT qualify as providing financial information You MUST log into your secure Peoria Recreation account to set up your default payment type.

Health Care Provider

Immunization Information

Medical Information