First United Methodist Church of Spring Hill
Monday, June 26, 2017

Summer Camp Registration

 
 

FIRST UNITED METHODIST SUMMER CAMP 2017

REGISTRATION FORM


 


 

CHILD'S NAME: _______________________________________________ AGE: __________


 

PARENT'S NAME: ___________________________________________________________________


 

BIRTH DATE: LAST GRADE COMPLETED: ________________________


 

FOOD/MEDICINE ALLERGIES: ______________________________________________________


 

CONCERNS WE SHOULD KNOW ABOUT YOUR CHILD: _______________________________


 

_______________________________________________________________________________________


 

MOTHER'S NAME: __________________________ HOME NUMBER: ______________________


 

CELL NUMBER: _________________________________________


 

WORK NUMBER: ___________________________ PLACE OF EMPLOYMENT: _______________


 

Email address:________________________________________________________________________


 


FATHER'S NAME: __________________________ HOME NUMBER: _________________________


 

CELL NUMBER: __________________________________________


 

WORK NUMBER: ___________________________ PLACE OF EMPLOYMENT: _______________


 

Email address:_________________________________________________________________________


 

OTHER PEOPLE ALLOWED TO SIGN OUT CHILD

OR TO BE CALLED IN AN EMERGENCY:


 

NAME: _____________________________________ RELATIONSHIP: ________________________


 

HOME NUMBER: ___________________________ CELL NUMBER: _________________________


 

WORK NUMBER: ________________________


 

NAME: _____________________________________ RELATIONSHIP: _________________________


 

HOME NUMBER: ___________________________ CELL NUMBER: _________________________


 

WORK NUMBER: ________________________


 

CHILD WILL ATTEND CAMP ____________ WEEKLY _____________ DAILY


 


 

EMERGENCY RELEASE FORM

NEEDS TO BE NOTARIZED


 

MEDICAL RELEASE


 

NAME OF CHILD PARTICIPANT ____________________________________________________


 

FULL ADDRESS __________________________________________________

 

____________________________________________________


 

DATE OF BIRTH ___________________________________________________


 

SOCIAL SECURITY NUMBER ____________________________________________________


 

EMERGENCY CONTACT PERSON ____________________________________________________


 

HOME PHONE _________________________________ WORK PHONE ___________________________


 

MEDICAL INSURANCE CARRIER ____________________________________________________

 

POLICY NUMBER ____________________________________________________

 

PLEASE LIST ANY MEDICAL ALLERGIES, MEDICATIONS BEING TAKEN, MEDICAL PROBLEMS OR OTHER PERTINENT INFORMATION: ____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


 

I UNDERSTAND THAT, IN THE EVENT MEDICAL TREATMENT IS REQUIRED, EVERY EFFORT WILL BE MADE TO CONTACT ME. HOWEVER, IN THE EVENT I CANNOT BE REACHED, I GIVE MY PERMISSION TO AN ADULT REPRESENTATIVE OF FIRST UNITED METHODIST CHURCH OF SPRING HILL TO SECURE THE APPROPRIATE AND NECESSARY CARE FOR MY CHILD.


 

(Parent or Legal Guardian...To be signed in presence of Notary)


 

SIGNED _________________________________________________ DATE ________________________


 

TO BE COMPLETED BY A NOTARY PUBLIC


 

State of Florida, County of __________________________________________________________

 

The foregoing instrument was acknowledged before me on this ______ date of ______________, 2017

 

by (print name) ______________________________ who is personally known to me, or has

produced (a type of identification) __________________________________ and did not take an oath.

Notary Public Signature _________________________________________________________________

 

Name of Notary (Print) __________________________________________________________________

 

 

My Commission expires: ________________________________________________________________

 

My Commission Number is: _____________________________________________________________


 

(NOTARY SEAL)

 


 

First United Methodist Church

9344 Spring Hill Drive

Spring Hill, FL 34608

352-683-2600 x 2016/2015


 


 

SUMMER CAMP 2017


 

DATES: Monday through Friday. Begins Friday, May 26

Closed Tuesday, July 4th - Independence Day 

TIMES: 6:30 am to 6:00 pm 

AGES: 4 years through 5 th grade. 

RATES: $25.00 Registration Fee Per Child 

WEEKLY: $75.00 - 1st Child DAILY: $25.00

$70.00 - 2nd Child

$65.00 - each additional child
 

Children may arrive and depart at any time between 6:30 am and 6:00 pm.

A $2.00 per minute late charge will apply after 6:00 pm.

The registration form, registration fee, and the notarized medical release form must be submitted to the church office before enrollment will be verified. Fees should be paid by cash, check, or money order and made payable to: First United Methodist Church of Spring Hill. Please put the child's name and dates of attendance on the memo line.

All weekly fees are due in the A.M. on the first day of attendance.

 

$2.00 late charge will apply for any P.M. payments.

 

If payment is not received by the a.m. on second day the child cannot be accepted for future attendance until paid.

 

All daily fees are due in the a.m. of each day of attendance. If the fee is not received by the p.m. pick-up, the child cannot be accepted for future attendance until paid.

 

Children shall be signed in and out daily. For your child's protection, please bring one form of identification when signing out your child. NO ONE WILL BE ALLOWED TO SIGN OUT YOUR CHILD WITHOUT PROPER IDENTIFICATION AND NAME ON FILE. Please keep us informed as to who is allowed to sign out your child. If a parent is restricted from signing out a child, please attach the proper legal document.

 

Each child should bring his/her own labeled lunch container. Please include extra drinks for snack time. A small cooler with an ice pack is best. Please remember to include any eating utensils. Lunchtime is at noon and snack times are offered at approximately 10:00 am and 2:00 pm. It is suggested that your child wear closed-toed shoes. Tennis shoes are preferred. Sandals may be worn on water days.

 

No medication or allergy treatment is allowed at camp without a note from a doctor; and medicine must be in a container with medical label. Any child with a contagious illness will not be accepted. If a child becomes ill at camp, the parent will be called for immediate pick-up.

 

The church will not be responsible for any lost or damaged games or toys which the child brings from home. We will allow special times for video games, which must be approved by the Camp Director. 

 

Outside groups will be bringing in programs (both educational and fun). There will be water days on the campus on Tuesdays and Thursdays, Bible lessons, singing, crafts and the children will be working on some kind of play or special program for Camp=s last week for the parents. Also, our puppets will be performing and the children will have the opportunity to work with puppets themselves during special class times. In addition, we will have outdoor recreation when weather permits and, on rainy days, will have game days inside. When possible, field trips will be planned.


ALL CHILDREN REGISTERED FOR THE WEEK OF JULY 24 – July 28 WILL BE REGISTERED TO ATTEND VACATION BIBLE SCHOOL (here at the church from 8:30am - 12 noon.). The Summer Camp Staff will transfer them from the Camp to Bible School and back to the Camp.

 

Parents/Guardians are responsible for the child's personal accident insurance. The staff and organization of First United Methodist Church are not responsible for the child's personal accident or injury insurance.


DISCIPLINE POLICY


The staff of First United Methodist Summer Camp will use positive discipline techniques such as rewards and consequences. The staff will keep parents aware of any serious discipline problems. Any child who is not able to follow the program guidelines will be Awritten-up@. Parent will be given copies of the write-up. Parents may also be called at home or work if a severe discipline problem occurs, which may result in the immediate pick-up of the child. These measures make the program safe and enjoyable for all.


 Thank you for sharing your child with us this summer. If you have any questions or concerns please call Ms. Pat’s office (683-2600 x 2016 /2015) and they will direct your call to the proper person.

 

IF THERE IS AN EMERGENCY AND YOU CAN NOT GET THROUGH TO THE NUMBER ABOVE, OR IF THE CHURCH OFFICE IS CLOSED, YOU MAY CALL MS. PAT ON HER

CELL PHONE, 352-346-9420.

 

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