CCCS CAMP SIGN-‐UP FORM PLEASE CIRCLE YOUR CHOSEN CAMP(S)
LEGO STEM CAMP #1 ART CAMP #2 ART CAMP DANCE CAMP June 17 – 21 June 24 – 28 July 8 – 12 July 15 – 19
Cost is $150 per camp, per child -‐-‐-‐-‐ Payment is required by first day of camp -‐-‐-‐-‐ 10% discount for 2 or more camps, if all camps are paid in full by the first day of the first camp. Child’s Name _______________________________________ Allergies _____________________________________ Age ______ Date of Birth ____________ _____________________________________ Parent Name _______________________________________ Medical Conditions ____________________________ Parent Phone Number _________________________ _____________________________________ Address ___________________________________________ Names of People Authorized to Pick Up Your Child Email Address ______________________________________ ____________________________________________ Emergency Contact Info ______________________________ ____________________________________________ __________________________________________________ ____________________________________________ I give permission for my child to walk with the group and camp counselors in and around Cape Charles. If necessary, I will apply sunscreen on my child in the morning. I give permission for the camp counselors to reapply sunscreen, if needed, which I will send in. I will send a lunch, a full water bottle and two snacks for my child each day. I understand that bottled water will be available for purchase, if necessary. Parent Signature _________________________________________ Date __________
CAPE CHARLES CHRISTIAN SCHOOL PO BOX #30 CAPE CHARLES, VA 23310 757-‐331-‐1717 debbie@cccsesva.org