S U M M E R

WEECare Preschool & Kindergarten

camps LIMITED SPACE

ages 2 - 6 years old 9:00am - 1:00pm daily

$45 PER DAY Or SAVE when you

register for All 5 Days For ONLY $200

June 13

SPACE CAMP!

July 11

Under the Sea!

July 25

BUGS!

August 8

PETS!

June 27

OutDoor

Adventure!

Name of Camper: ________________________________________________________

Age: ______________ DOB: _______________ Potty Trained? _____ Y _____ N

Parents’ Names: _________________________________________________________

Address: _______________________________________________________________

_______________________________________________________________

Phone: ____________________________ Email: ______________________________

Emergency Contact/Phone: _______________________________________________

Persons authorized to pick up camper (other than parents):

_______________________________________________________________________

Persons NOT authorized to pick up camper:

_______________________________________________________________________

2017 Summer Camp REGISTRATION

SUMMER CAMP DATES:

Cost of Camp per camper is $45/day or $200/all 5 days

A $45 non-refundable deposit per camper holds spot

Registration is due with full payment by May 15.

Registrations at the door will not be accepted.

Tuesday, June 13 — Space Camp

Tuesday, June 27 — Outdoor Adventure

Tuesday, July 11 — Under the Sea

Tuesday, July 25 — BUGS!

Tuesday, August 8 — Pets

TOTAL COST: $_________________

Backside of Registration Form must be completed with Parent Signature.

WEECare PRESCHOOL & KINDERGARTEN

WEECare Preschool & Kindergarten 2017 SUMMER CAMP Registration

______________________________________________________________________________________________________________________

IMPORTANT

In order to reserve your child’s spot for Summer Camp, a minimum of $45 non-refundable deposit with a completed registration form is due

immediately. Outstanding balances must be paid by May 15, 2017.

EMERGENCY AUTHORIZATION

Parents/guardian will complete and return an Emergency Medical Authorization Permit Form prior to the start of camp. Parent/guardian under-

stands that they will provide permission to the physician selected by the camp leader to hospitalize and secure proper treatment for the camper if

parent/guardian cannot be reached in the event of an emergency. Parent/guardian will be fully responsible for any costs of such treatment, even

if not covered by insurance.

CONSENT TO CONDITIONS

Drop Off Time: 9:00am (Parents may drop off via carpool line at the main foyer doors)

Pick Up Time: 1:00pm (Parents must park and come in to sign out child(ren)

Lunch: Students will supply their own disposable lunch daily. Additional snacks will be provided by the program.

Supplies: Students should bring a water bottle, sunscreen, and an extra change of clothes, and diapers (if applicable) each day.

PARENT/GUARDIAN PERMISSION

My signature below indicates that I have the legal authority to sign up the child(ren) named on this form and the information listed is complete

and correct. I further understand that this is an application and the named child(ren)’s participation is contingent upon space being available in

the program. Once the application is confirmed, my deposit becomes non-refundable. All additional payments and forms are due prior to the first

day of camp.

Parent/Guardian

Name_______________________________________________________________

Signature______________________________________________________________________________ Date ____________________________

WEECare Preschool & Kindergarten EMERGENCY MEDICAL AUTHORIZATION PERMIT

Whenever my child is involved in a school activity and I am unavailable or otherwise unable to provide authorization directly, I do hereby grant to

the school director or his/her designee the authority to act for me and to provide any required consents and authorization for the delivery of

emergency medical care, diagnoses, and treatment, including surgical intervention, if necessary, on behalf of my minor child listed below and to

do all other necessary things as I might or could do to provide for the child’s health and safety, if I were present.

Child’s Name: _________________________________________________________________________________________________________

(Last) (First) (Middle)

School: ____________WEE CARE PRESCHOOL___________ Class:______2017 SUMMER CAMP_________ Teacher:_______________________

Parent or Guardian Names:______________________________________________________________________________________________

Home Address:________________________________________________________________________________________________________

(Street) (City) (State) (Zip)

Mother’s Employer: _______________________________________ Father’s Employer: _____________________________________________

(Phone No.) (Phone No.)

Doctor Preferred:________________________________________________________________________________________________________

(Name) (Address) (Phone No.)

Dentist Preferred: _______________________________________________________________________________________________________

(Name) (Address) (Phone No.)

Insurance Company:______________________________________________________________________________________________________

(Insurance Identification No.)

Allergies:_______________________________________________________________________________________________________________

Medical Conditions:_______________________________________________________________________________________________________

Previous Operations / Hospital Confinements:__________________________________________________________________________________

Authorized Signature: _____________________________________________________________________________________________________

(Parent / Guardian) (Date)