2010 summer camp registration form Please mail the completed form and a check to:
Charlotte Christian School • Attn: Summer Camp • 7301 Sardis Road • Charlotte, NC 28270 To register online go to www.charlottechristian.com.
First
Middle
Date of Birth
Address
City
State
Parent’s Name
Home Phone
Emergency Phone
Preferred E-mail
Applicant’s School
Zip
Grade Entering Fall of 2010
emergency medical information
Physician’s Name
Physician’s Phone Number
Insurance Company
Policy Number
Local Emergency Contact (Other Than Parent)
Home Phone Number
Hospital Preference
Cell or Work Phone Number
Please list any special medical conditions of which the school should be aware. (ex. known allergies)
field trip/transportation form I hereby give permission to Charlotte Christian School to provide transportation to the Swim and Tennis Center pool and summer camp field trips. I hereby agree to hold the school harmless in case of accident or injury to my child. I understand that, in case of medical emergency, every effort will be made to contact me. If the school personnel are unable to contact me, or if time is of the essence, I give permission for emergency medical treatment and agree to assume any costs involved in such treatment. The school and its personnel, for its part, agree to act in a prudent, reasonable and responsible manner in all cases, acting in “loco parentis” and to take all reasonable and prudent care.
______ Parent/Guardian Initials
waiver The following MUST BE SIGNED by parent/guardian of ALL REGISTRANTS in order to participate in ANY program or course. In the event that my child needs medical attention, I authorize the school and give my consent to the school to provide such service and/or to transport my child to a hospital or treatment facility. I hereby certify my child is in good health and may participate in all activities. The parent’s signature below indicates the agreement of the parent and the student to abide by the summer school policy on the inside back cover. All camps are non-refundable within one week of the start of the camp, unless the school cancels a course.
Parent’s Signature
Date
(over)
registration form
Last
Camps Each camper will receive one Expanding Your Horizons Summer Camp T-shirt. Below are the sizes available. Youth: Small, Medium, Large • Adult: Small, Medium, Large, X-Large Camp
Date
Shirt Size
Cost
Total due for camps
registration form
Extended Care Lunch care is located in the Flenniken Dining Hall. Camper must bring a bag lunch. Dates
Early Care 7:30 - 9 a.m.
Lunch Care Noon - 1 p.m.
Extended Care 4 - 6 p.m.
May 31 - June 4
$50
$10
$55
June 7- 11
$50
$10
$55
June 14 - 18
$50
$10
$55
June 21 - 25
$50
$10
$55
June 28 - July 2
$50
$10
$55
July 12 - 16
$50
$10
$55
July 19 - 23
$50
$10
$55
July 26 - 30
$50
$10
$55
August 2 - 6
$50
$10
$55
Weekly Fee
Total due for extended care
Subtotal Early Bird Registration Fee (by May 17): $25 Registration Fee (after May 17): $35 Total
NOTE: Registration must be completed by Monday, May 17, in order to adequately staff the camp and maintain a fun and safe environment for all. Enrollment in any camp/course requires a one-time per child $25 non-refundable deposit that is in addition to the camp fee. A $10 fee is accessed for any changes. The camp fee is due a week prior to the first day of camp. All camps are non-refundable within one week of the start of the camp, unless the school cancels a course. Charlotte Christian School reserves the right to combine appropriate classes based on enrollment. All checks should be made payable to Charlotte Christian Summer Camps.