2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy & Expression Arts Camp Registration

2026 Summer Camp S.M.I.L.E. | Science, Math, Innovative Thinking, Literacy, & Expressive Arts Camp Registration

Welcome to 2026 Camp SMILE: Where one can EMOJI the Possibilities of Fun... Summer Camp Location: 6635 Highway 98 West, Suite 100, Hattiesburg, MS 39402 Email: TheAppleOrchardAcademy@gmail.com Phone: 601-336-9270
Camper's Information:
Camper's Name:

First NameLast Name
Camper's Date of Birth:

MonthDayYear
Date
Child's Social Security Number (Proof of Identification):
Camper's Gender
Camper's School of Attendance:
Camper's Grade Level: 2026-2027
Camper's T-Shirt Size:
Returning Camper (Attended Prior Summer Camp)
Returning Enrollee (Attended ANY programs | Preschool - 3rd Grade, After-School Program, Tutoring)
Camper's Allergies (Food and/or Environmental)
Program Specific Academic Concerns
Has your camper ever been grade-retained or repeated a grade? (For Enrichment/Tutoring Purposes Only)
Has your camper been diagnosed with any learning, language, or cognitive disability (Speech, Hearing, Dyslexia, Language Processing, etc.), or behavioral disability/concern (ADHD, etc.)?
Please list all diagnoses:
Camper's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #1 Information:
Parent/Guardian #1

First NameLast Name
Driver's License Number (Proof of Identification):
Phone Number for Parent/Guardian # 1:
Please enter a valid phone number.Format: (000) 000-0000.
Email for Parent/Guardian # 1:
example@example.com
Address for Parent/Guardian #1:

Other
Address (cont.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment for Parent/Guardian #1:
Employment Contact for Parent/Guardian #1:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian # 2 Information:
Parent/Guardian #2

First NameLast Name
Driver's License Number (Proof of Identification):
Phone Number for Parent/Guardian # 2:
Please enter a valid phone number.Format: (000) 000-0000.
Email for Parent/Guardian # 2:
example@example.com
Address for Parent/Guardian #2:

Other
Address (cont.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment for Parent/Guardian #2:
Employment Contact for Parent/Guardian #2:
Please enter a valid phone number.Format: (000) 000-0000.
Work Address for Parent/Guardian # 2:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list names and phone numbers of emergency contacts
Authorized Pickups:

Other
Parent Responsibility | Financial Commitment

Please list the name of the individual(s) that will be responsible for payment. All parties will be required to sign a hard-copy Parent Responsibility | Financial Commitment form.
Name

First NameLast Name
Relationship to camper
Name

First NameLast Name
Relationship to camper
2026 Summer Camp S.M.I.L.E. | Activity Schedule | Calendar
2026 Summer Camp S.M.I.L.E. Closures
May 2026 Closure
June 2026 Closure
July 2026 Closure
Acknowledgements| Authorizations| Permission Forms
2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy, and Expression Camp
Camp S.M.I.L.E.| Science, Math, Imagination, Literacy, and Expression Camp Registration Fee:
Financial Commitment | Limited Enrollment: 2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy, and Expression Camp
2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy, and Expression Camp Withdrawal Policy:

I understand 2026 Summer Camp S.M.I.L.E: Science, Math, Imagination, Literacy, & Expression Camp is a binding financial commitment. Withdrawal from the program will be granted PRIOR to the START of summer camp with NO REFUNDS for any payments made prior to withdrawal. After summer camp has started, parents will be financially responsible for the remaining balance through their financial commitments.
Enrollment: 2025 Summer Camp BLAST: Bridging Literacy, Art, Science and Teamwork
Registration Fee: 2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy, and Expression Camp
Enrollment: 2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy, and Expression Camp
Promotional Code: 2026 Summer Camp S.M.I.L.E. | Science, Math, Imagination, Literacy, and Expression Camp
Weekly Camp Options:
Field Trips: 2026 Summer Camp S.M.I.L.E.| Science, Math, Imagination, Literacy, and Expression Camp
Tshirt Fee:
Tuition Policy:
Tuition Schedule:
Declined Payment/Insufficient Fund Charge:
Late Payment Fee:
Suspension of Services:
Payment Authorization:
No Refund/Non-Attendance Policy:
Camp No Refund/Non-Attendance Policy
Tuition Discount Policy
Multi-Child Discount:
Monthly Payment Discount:
Tuition Assistance Scholarship:

I understand The Apple Orchard Academy's Gift of Reading: Tuition Assistance Scholarship provides an opportunity for eligible families to receive financial support to aid in enrollment for their student to attend or receive supplemental support within one of our specialized, high-quality literacy-focused, educational enrichment program (preschool, after-school enrichment, tutoring, and/or summer day camp.) Recipients of the scholarship must share our programs values and be willing to make a commitment to their student's educational journey and program's development.
Application Process:
Priority Applicants:
Special Needs Program Disclosure:
Behavioral Policy:
Transportation Permission Form
Field Trip Permission Form
Summer Park Days 2026

The Apple Orchard Academy will travel to several parks thoughout the summer including but not limited to Midtown Green and Payne Playground (Hattiesburg), Hinton Park (Petal), Optimist Park (Oak Grove), Kemper Park (Hattiesburg) and/or recreational parks within the city limits and surrounding cities. I understand that my child is to bring a water bottle, towel and wear close-toed shoes. I grant permission for my child to attend said parks throughout 2026 Summer Camp S.M.I.L.E: Science, Math, Imagination, Literacy, and Expression Camp.
Field Day Fridays 2026

I authorize permission for my child to participate in Field Day Fridays during 2026 Summer Camp S.M.I.L.E: Science, Math, Imagination, Literacy, and Expression Camp. Field Day Friday is considered a team building opportunity with friendly challenges, races and activities. I understand that my child is to bring a water bottle, hat, sunscreen and wear close-toed shoes for all field day activities. I understand that Field Day Fridays will be held at Hinton Park in Petal, Mississippi.
Water Play Days 2026
Photography, Media Release & Social Media Permission 2026
Code of Conduct Policy

I acknowledge and understand The Apple Orchard Academy requires all employees, students, and family members of enrolled children to behave in a manner consistent with decency, courtesy, and respect. Our goal is to provide the most appropriate environment in which a child can grow, learn, and develop. Achieving this ideal environment is not only the responsibility of the employees but is the responsibility of every student, parent or adult who enters the facility.
Grievance Policy

I acknowledge and understand all families have the right to bring a grievance and it is a fundamental principle of this policy that no family shall be subject to any detriment for having raised a grievance in good faith. Where a grievance is raised maliciously, i.e. where grievance was on grounds which they knew to have been false with the intention of harming the program, legal actions may be taken against the individual/family raising the grievance at individual's or family's expense. Slander or defamation of program will not be tolerated.
2026-2027 AFTERSCHOOL ENRICHMENT AND TUTORING PROGRAM
Are you interested in joining our 2026 After-School Enrichment & Tutoring Program?
Time

Hour Minutes

AM/PM Option
Signature
Should be Empty:

2026 Summer Camp S.M.I.L.E. | Science, Math, Innovative Thinking, Literacy, & Expressive Arts Camp Registration

Camper's Information:

Parent/Guardian #1 Information:

Parent/Guardian # 2 Information:

Parent Responsibility | Financial Commitment

2026 Summer Camp S.M.I.L.E. | Activity Schedule | Calendar

2026 Summer Camp S.M.I.L.E. Closures

Acknowledgements| Authorizations| Permission Forms

Camp No Refund/Non-Attendance Policy

Tuition Discount Policy

2026-2027 AFTERSCHOOL ENRICHMENT AND TUTORING PROGRAM