regi

stra

tion

form

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

Physician’s Name Physician’s Phone Number Hospital Preference

Insurance Company Policy Number

Local Emergency Contact (Other Than Parent) Home Phone Number 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

Last First Middle Date of Birth

Address City State Zip

Parent’s Name Home Phone Emergency Phone

Preferred E-mail Applicant’s School Grade Entering Fall of 2011

(over)

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.

waiver

emergency medical information

21

2011 summer camp registration form

registration form

NOTE: Registration must be completed by Monday, May 16 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 one 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.

Campers should bring a snack and a water bottle to camp every day.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 Cost

Total due for camps:

Camps

22

DatesLunch Care*

Noon - 1 p.m.Extended Care

4 - 6 p.m.Weekly Fee

June 6 - 10 $50 $55

June 13 - 17 $50 $55

June 20 - 24 $50 $55

June 27 - July 1 $50 $55

July 11 - 15 $50 $55

July 18 - 22 $50 $55

July 25 - 29 $50 $55

August 1 - 5 $50 $55

Extended Care

Total due for extended care

Subtotal

Early Bird Registration Fee (by May 16): $25 Registration Fee (after May 16): $35

Total

Lunch care is located in the Flenniken Dining Hall. Camper must bring a bag lunch.

* No charge for full day campers or campers attending the afternoon sessions.

EarLy CarE: Provided on a needed basis. Must be pre-registered for planning purchases. For more information please contact Allycia Brown at allycia.brown@charchrist.com or (704) 366-5657 ext. 2003.

T-shirt Size: