Atonement Summer Camp Registration

Camp Registration Form

Atonement Summer Camp
Join us for a fun-filled summer learning about Jesus, playing games,

making crafts, learning new skills, and so much more!

The Philadelphia Project in partnership with Atonement Church strives to provide affordable, Christian children’s programming to the Northwest section of Philadelphia. We do this by offering early childhood education through our education assistance through our afterschool program, and planned activities through our summer camp.

In order for your child to participate in these programs, you must complete this application. All information is required in order for your student to be registered and attend.

This application and the accompanying fee is the first step in registration. Once your application has been processed you received a confirmation email with the remaining balance due. Your spot in camp will not be secured until the application is submitted and after you have received a confirmation email from atonementcamp@gmail.com.

If you do not have a recent health report for your child on file with us, you can dowload the form here.

DETAILS
- June 22-July 10 / 8:00AM-3:00PM
  $65/week
- Aftercare is available until 6:00PM for an additional $25/week (space is limited)
- Snacks are provided, but you must pack a lunch each day
- Summer camp is for children 1st grade-entering 6th grade
If you have any questions, please contact us at atonementcamp@gmail.com. We are looking forward to a fun-filled summer with your camper!

The Philadelphia Project Atonement Program
6100 Greene Street
Philadelphia, PA 19144
Telephone: 267-793-0320
The Philadelphia Project is an equal opportunity provider.
We do not discriminate against on the basis of race, religion or gender.
Camper's Information
Camper Name*
Date of Birth*

MonthDayYear
Age first day of Camp
Entering Grade in 2020/21*
Sex

MaleFemale
Registering for the following weeks of Camp (8:30 AM-3:00 PM)

Week 1 - June 22-26Week 2 - June 29- July 3Week 3- July 6 -10
Registering for the following weeks of Aftercare (3:00-6:00 PM)

Week 1 -June 17-21Week 2 - June 24-28Week 3- July 6-10

Caregiver Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Cell Phone*
Home Phone
Work Phone
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
Caregiver Information

Parent/Guardian 2
Parent/Guardian 2*

First NameLast Name
Relationship to Child*
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Cell Phone*
Home Phone
Work Phone
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts

Parents are the first emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. These individuals will also be approved pickups. Any person listed should be able to assist in contacting you, able to take responsibility for the child in case the parent/guardian cannot be contacted, and should be at least 18 years of age.
Emergency contact #1*

First NameLast Name
Phone Number*
Relationship to Child
Emergency contact #2*

First NameLast Name
Phone Number*
Relationship to Child
Emergency contact #3 Name*

First NameLast Name
Phone Number*
Relationship to Child

Approved Pickups

Parent/Guardians and Emergency Contacts are approved pickups. Please list additional approved pickups here if desired. Person MUST be over 18 years of age and have ID when arriving.
Pickup Person #1

First NameLast Name
Phone Number
Relationship to child
Pickup Person #2

First NameLast Name
Phone Number
Relationship to child
Pickup Person #3

First NameLast Name
Phone Number
Relationship to child
Pickup Person #4

First NameLast Name
Phone Number
Relationship to child

Photograph/Media release authorization on behalf of The Philadelphia Project
Child's Name

First NameLast Name
YES, I do give permission to have my child appear in any media coverage (t.v., newspaper articles, photographs, website) on behalf of The Philadelphia Project

Parent/Guardian Agreement

Please review the following policies and initial each
General Policies
1. I am enrolling my child in TPP’s Children’s Programs at Atonement Church.
2. I understand that there is an application fee of $20.
3. I understand there is a tuition fee which is due by the due date via Brightwheel or by check.
4. I understand that TPP will be providing Summer Camp from the hours of 8:00 AM- 3:00 PM (plus aftercare until 6PM if enrolled).
5. I understand that my child will not be dismissed from the program without being picked up by a parent designated adult.
6. I understand there will be a $15 fee will be added every 15 mins for any late pick-ups.
7. I understand that disrespect, fighting, physical and verbal aggression will not be tolerated in this program. In accordance with the Parent Handbook disciplinary procedures, I understand that my child could lose their position in the program and may be discharged immediately for such actions.
8. I understand that if a medical emergency arises, program staff will attempt to contact parents or the emergency contact that I have indicated. It is the parent’s responsibility to notify the staff if this information changes. If immediate medical attention is necessary, an ambulance or emergency vehicle may take my child to the hospital of their choice.
9. In cases of illness, I understand that my child may not be permitted to attend the program. If staff feels that a child has a contagious disease, he/she may not return to the program without a doctor’s note.
10. In order for my child to be considered for this program I understand that I must complete all enrollment paperwork and health assessments.
11. I understand that TPP Children’s program are faith-based (Christian).
12. I have received complete program information (handbook) at the time of enrollment (PA Code 3270.121, 3280.121, 3290.121)
13. I agree to update the emergency contact and parental agreement when changes occur or every 6 months at a minimum. (PA Code 3270.124, 3280124., 3290.124)
I have read and understand the General Policies.*
Non-discrimination in Services
SUBJECT: Nondiscrimination in Services

TO: Parents/Guardians

FROM: Alena Beeman (Fuel:Germantown Director)

Admissions, the provisions of services and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age or sex.
Program Services shall be made accessible to eligible persons with disabilities through the most practical and economically feasible methods available. These methods include, but are not limited to, equipment redesign, the provision of aides and the use of alternative service delivery locations. Structural modifications shall be considered only as a last resort among available methods.
Any individual/client/patient/student (and/or their guardian) who believes they have been discriminated against, may file a complaint of discrimination with:
The Philadelphia Project
8230 Ridge Ave.
Philadelphia, PA 19128

Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity
Room 225, Health & Welfare Building P.O. Box 2675
Harrisburg, PA 17105

U.S. Department of Health and Human Services
Office for Civil Rights
Suite 372, Public Ledger Building 150 South Independence Mall West
Philadelphia, PA 19106-9111

PA Human Relations Commission
Harrisburg Regional Office
333 Market Street, 8th Floor Harrisburg, PA 17101
I have read and understand the nondiscrimination in services notice*
Dismissal, Discipline, and Discharge Policy
1. Children are not permitted to arrive alone and must be signed in by an adult.
2. Children are only permitted to be signed out by an approved pickup over the age of 18.
3. The fee for late pick up is $15 per 15 minute interval. Excessive lateness will be reviewed.
4. Children are not permitted to bring any toys from home.
5. A child who displays chronically disruptive behavior may be suspended or discharged at the discretion of the camp supervisors.
6. Unacceptable Behavior of the Participant:
  1. Spitting, biting, or hitting
  2. Inflicting physical harm on other children on staff
  3. Inappropriate language or drawings
  4. Using profanities or obscenities
  5. Ridiculing or bullying other children
  6. Taking other children’s belongings
  7. Destruction of school or personal property
  8. Ignoring or disobeying the rules during the program times
I have read and understand the Dismissal, Discipline, and Discharge Policy*
Sign Document*
Parent/Guardian Signature
Date Signed*

MonthDayYear

Total $0.00

Credit Card

Should be Empty:

Camp Registration Form

Camper's Information

Caregiver Information

Caregiver Information

Emergency Contacts

Approved Pickups

Medical / Health Information

First Aid and Emergency Medical Care Consent

Administration of Medication Consent Form

Photograph/Media release authorization on behalf of The Philadelphia Project

Parent/Guardian Agreement

Non-discrimination in Services

Dismissal, Discipline, and Discharge Policy

Credit Card