Elementary SUMMER CAMP 2015
CAMP NEXT GEN
One Week Long
Inventors, Inventions, and more!!
Weird Science
June 15 - June 19
Come build bridges, come up with new
inventions and more!! Can you be the next
Albert Einstein?? Come bring out the inventor in you!!!
June 22 - June 26
Mon-Fri, 1pm - 5pm
Hands-on science experience! Each
day we will dive into a
different science topic and
learn more about the world
around us with f un
experiments and more!
Kids Entering 1-6
Top Chef
Camp Shakespeare
July 13 - July 17
July 6 - July 10
Come learn theatre techniques, while discussing different Shakespeare playwrights, explore theatre makeup, and create your own costumes. This is a fun, energetic
acting camp!
1/2 Day Camps
It takes more than a measuring cup
and chefs hat to make you a chef!
Campers will spend
each day working in the
k itche n
to
crea te
fabulous foods and a
little friendly competition.
Sign up for all 4 camps and
get $50 off final camp!
Must register by May 1 to
receive discount!
All Camps Located at
New Creation Church
7275 Santa Teresa Blvd
More details: www.newcreationchurch-sj.org
Please check each day camp you are registering your child in.
Inventors, Inventions, and more June 15 - June 19
$140
1/2 Day 1pm-5pm
Day Camp ____
Weird Science
June 22 - June 26
$160
1/2 Day 1pm-5pm
Day Camp ____
Camp Shakespeare
July 6 - July 10
$120
1/2 Day 1pm-5pm
Day Camp ____
Top Chef
July 13 - July 17
$160
1/2 Day 1pm-5pm
Day Camp ____
You may write out one check (for families) for the total down payment, please attach all paperwork together so that the office is
clear. There is a one time non refundable registration fee of $20. There is a $50 deposit for each camp that you choose to register
for each camper.
Checks payable to:
One Time Registration Fee =
$20 (a)
New Creation Church
Total # Of Sessions Attending _____ x $50 (deposit)* = _______ (b)
Or Pay by Credit/Debit Card
Total Payment Enclosed is a + b = _________
*Balance is due the first day of each camp
7275 Santa Teresa Blvd.
San Jose, Ca 95139
www.NewCreationChurch-sj.org
408-800-2113
A 501(c)3 non-profit corporation #77-0319494
Approval for distribution of these materials does not imply endorsement by the Morgan Hill Unified School District (Board Policy 1325)
Please complete a separate application for each child who will attend camp!
Campers First Name __________________________ Campers Last Name ________________________________
Home Address _________________________________________ City ______________________ Zip __________
Email Address ________________________________________________ Home Phone _____________________
Parent/Guardian Name _____________________________ Day Phone ____________ Cell Phone _____________
Parent/Guardian Name _____________________________ Day Phone ____________ Cell Phone _____________
Child Lives With (please check) Both Parents
Mother
Father
Other _____________
Child’s Date of Birth: ____________ Grade Level in Fall _____ Child’s Shirt Size Youth: S / M / L / XL Adult: S / M / L / XL
EMERGENCY INFORMATION
Name _____________________________ Phone ___________________ Relationship to Child ________________
Name _____________________________ Phone ___________________ Relationship to Child ________________
Name _____________________________ Phone ___________________ Relationship to Child ________________
Health Ins Co _______________________ Policy or ID # ______________Name on Policy ____________________
Child’s Dr.’s Name __________________ Phone ____________________ Address __________________________
Allergies or Medications Taken____________________________________________________________________
Please Read Carefully and Sign Below
Publicity Release:
I give permission for any photos, videos, or quotes taken of my child to be used for Next Gen/New Creation Church publicity
including, but not limited to newsletters, summer brochures, websites, and promotional videos.
Transportation Release:
I allow for Next Gen/New Creation Church to provide transportation, if needed, to my child in order for them to participate in any
program conducted off the grounds of the day camp facility.
Liability Release:
I, the undersigned, give permission for my son or daughter to participate in the activities that occur at Next Gen Day Camp/New
Creation Church. I agree to release and hold harmless Next Generation & New Creation Church, its officers, Board, agents,
servants, or employees, for any and all claims for injuries, causes of action, or liability related to my child’s participation in any
activity occurring with Day Camp. The release does not apply to intentional and/or willful acts of misconduct by Next Gen/New
Creation Church or any of its officers, agents, Board, servants, or employees.
Consent for Treatment:
I do hereby authorize an official of Next Gen/New Creation Church to provide routine health care and seek emergency medical
treatment including but not limited to ordering x-rays and/or routine tests. I agree to the release of any records necessary for
insurance purposes. I give permission to Next Gen/New Creation Church to arrange necessary related transportation for my
child. I further agree to accept full financial responsibility for medical treatment.
Signature and Consent:
I, the parent or legal guardian of (NAME OF MINOR) ______________________________________________, understand the
activities offered by Next Gen/New Creation Church located in the city of San Jose and in the County of Santa Clara, and within
the State of California, beginning on the day of 06/15/2015, and ending on the day of 7/17/2015, and I have had sufficient
opportunity to read this entire document and have understood it and agreed to be bound by its terms. As the parent or legal
guardian of my child, I hereby consent for my child to attend and participate in all activities provided by Next Gen/New Creation
Church. By signing below I agree to the above stated conditions and shall hold harmless both Next Gen & New Creation
Church.
_____________________________________________________________________________________________
(SIGNATURE OF PARENT OR GUARDIAN)
(PRINTED NAME)
(DATE)