Summer Camp Student Registration

Guideline:
- Breakfast and lunch will be served
- $110/student for registration and tuition
- We accept 2nd - 9th grade ( students who completed 1st grade thru 8th grade this school year)
- 24 students per Grade (12 students per teacher)
- We offer Bible, Math, English Reading & Writing & PE
- 192 Students Total
- 3 days a week (Tuesday, Wednesday, Thursday)
8 am to 3pm
- Five weeks class starting June 11th to July 11th
- Students need to be picked up from the Church gym between 2:45 pm to 3pm
- On June 11 @ 7:45 am Parent Orientation will be given and attendance is encouraged.

You must read the guideline before registration. Did you read the guideline above?

Yes

Student Information

(For students who are completed 1st - 8th grades only)

Student Name

Date of Birth

Gender

Next Year Grade: (Note: If you don't see the grade, sorry it's full)

Allergies

Parent / Guardian Information

Father's Full Name

Mother's Full Name

Address

Phone (Mother)

Phone (Father)

This address will receive a confirmation email

Emergency Contact Person

Emergency Contact Phone

Summer School Liability Waiver Form

Publicity: I authorize the Ethiopian Evangelical Baptist church to take picture of my child during summer school activities for non-promotional uses and slide show for the closing programs. Initial below

Medical custody Release: I authorize the summer school leadership of the Ethiopian evangelical Baptist church to seek and authorize medical attention in the event my children need medical care for emergency reason. I understand a call will be made to the parents/guardians, however, if contact cannot be made on first call, assistance will be authorized by the church’s summer Camp 2016 leaders. Initial below

Release of Liability: I understand there are risks associated with all activity including summer camp activity. I agree not to hold the Ethiopian evangelical Baptist church, its leader and Volunteer servant liable for any claims of damages or injury to my children or my children’s property that may occur through the normal course of summer camp. I understand the summer camp leadership will make every reasonable attempt to provide a safe and caring environment for my children. Initial below

I have read all the information on this registration form. Initial below

By selecting "I agree", I grant consent to all permission and agree to all waivers on the form. Initial below

If you agree, check

I agree

Full Name of Parent / Guardian (Please Print)

Relationship to child

Father Mother Guardian

Address

Primary Phone

Phone

Date

Payment Information

Payment $110

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Summer Camp Student Registration - 2024

Description

Summer Camp Student Registration - 2024

Description

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