Kids of the Kingdom
Kids of the Kingdom Summer Day CampNew Location for 2007!
St. Elizabeth Church of God by faith
1218 Old Apopka Road
Apopka, FL 32703
MR. Willie Johnson, Director
(407) 756-9742(C)
Name:_____________________________
SSN:______________________________
Address:___________________________
City:______________________________
State:___________
Zip:_____________
Name of School:_______________________
Grade: ________
Date of Birth:___/___/___
Home Phone:( ) __________________
Mother:_____________________
Father:____________________
Work Phone: ( ) _____________
Home Phone: ( ) ____________
Cell/Pager: ( ) ______________
Cell/Pager: ( ) _____________
Emergency Contact
Name:_____________________________________
Address:________________________
Phone: ( ) ________________
Medical Information:
My child is covered by insurance. YES or No (circle one)
Insurance Company:___________________
Policy Number:____________
Doctor:____________________________
Doctor Phone: ____________
Preferred Hospital:________________________
List Current Medications:_____________________
________________________________
List any allergies or medical problems:_______________________
_______________________________
_______________________________
_______________________________
Kids of the Kingdom Summer Day Camp Contract
Camp tuition is $20 weekly and due the first day of the camp week. Tuition can be paid by cash or check/money order payable to Kids of The Kingdom, . If payment is not made by the third weekday, the camper will be suspended for Kotk until account is made current. Weekly tuition includes all field trips and meals.
I AGREE_________
If a camper breaks camp rules, that child will be placed in time-out accordingly. If your child consistently displays disruptive behavior, the director will contact the parents for a conference. After a conference, if your child continues to display disruptive behavior, then your child will be expelled from the Kids of The Kingdom Summer Day Camp.
I AGREE_________I, ________________ give permission for my child, ________________, to go on field trips with Kids of The Kingdom Summer Day Camp program. I also will not hold Kids of The Kingdom, its staff, volunteers, or anyone associated with the program responsible or liable for any accidents, sickness, or injuries that may occur during the course of the camp. I will provide medical insurance coverage for my child. Also, if he or she is injured due to his of her disruptive behavior, i.e., fighting, horse playing, etc., I will not hold Kids of The Kingdom or anyone associated with the organization responsible or liable for any medical bills.
I AGREE__________
In case of emergency, and I cannot be reached, I give permission to Kids of The Kingdom staff to call 911 and get medical attention for my child.
I AGREE __________
All campers must wear closed-toe shoes for safety. Campers can wear what they choose within modesty. Due to the weather and activities, T-Shirts and shorts would be best. ALL CAMPERS MUST WEAR THEIR CAMP T-SHIRTS ON ALL FIELD TRIPS!
I AGREE___________
Parent Participation is very important to a child as he or she is growing up, therefore we ask that you join us for field trips and other activities when possible. Friday, July 13, 2007 will be our closing awards ceremony, and we are asking that all campers and their parents be in attendance.
I AGREE___________
** THIS CONTRACT MUST BE NOTARIZED BEFORE YOUR CHILD CAN ATTEND Kids Of The Kingdom SUMMER DAY CAMP. **
I have read and fully understand the terms of the contract agreement of the Kids of the Kingdom Summer Day Camp. I have initialed each term and will abide by them. By signing below I agree to each term of this contract.
_______________________ ________________(Parent/Legal Guardian)
(Date) Sworn and subscribed to before me this _________ day of ________________________. ___________________________ Notary Public