Summer Camp Registration Form
Dear Parents:
Registration for summer camp is finally here! Grace Lutheran School offers a Christian based summer
program filled with exciting events and fun filled camps. Each week your child will get to participate in a
new thematic experience – learning, while having a great time! Our certified staff will challenge and
guide your child through their best summer EVER!!
To register for each summer camp session, simply return this form noting the days your child will be in
attendance. A non-refundable 2015 Summer Registration Fee will reserve your selected sessions. Camp
tuition is due the Friday before the first day of each session, and is payable by check, cash, or credit
card, in our office. Summer Camp sign ups need to be turned in to Mrs. McIntee or Mrs. Woods, 863293-9744, no later than May 30th. Please fill out 1 form for EACH child (see reverse side).
**New students to Grace Lutheran must also submit an enrollment registration form**
Rates are as follows:
Summer Camp Registration Fee (Grace Lutheran Students)
Summer Camp Registration Fee (Non Grace Lutheran Students)
$50.00
$75.00
Summer Camp Tuition:
Completed PreSchool 2’s through Completed PK4’s
Completed K – 5th Grade
Drop In Rate (2 Days advance notice required)
$120.00/week
$110.00/week
$30.00/day
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If you need to cancel a camp that you have signed up for, you will need to cancel 3 days in
advance, otherwise, the charge will remain on your child’s account. We must staff the rooms
according to registrations.
All camps will be charged at the beginning of summer and adjusted weekly as needed.
STUDENT INFORMATION SHEET
(Please return to the school office no later than May 29th)
Child’s Name:_________________________________________ Date of Birth: ____________________
Grade Completed: ________
Medical Needs/Allergies: ________________________________________________________________
Mother’s Name: _____________________________________ Phone Number: ____________________
Father’s Name: ______________________________________ Phone Number: ___________________
Mailing Address: _______________________________________________________________________
_____________________________________________________________________________________
Email Address: ________________________________________________________________________
Emergency Contact Name: __________________________________ Phone Number: _______________
Emergency Contact Name: __________________________________ Phone Number: _______________
Emergency Contact Name: __________________________________ Phone Number: _______________
Emergency Contact Name: __________________________________ Phone Number: _______________
___________________________________________________
Parent Signature
____________
Date
FOR OFFICE USE ONLY:
____ Registration Fee
____ Camp Session Sheet
____ Immunization Form (PS2 – PK4)
____ Swim Lesson Form/Field Trip Form
____ Physical Form (PS2 – PK4)
____ Parent Contract
SUMMER CAMP PARENT CONTRACT
I, _____________________________________________, the undersigned parent understand
the following:
____ I am to pay the first Monday of each week for my child’s summer camp session.
____ I am to pay the final summer camp balance by July 31 (which will include the week of
August 7).
____ If I fall 2 weeks behind without communication with the school office, my child will be
unable to attend summer camp.
____ If I do not pick up my child by 6:00pm, I will be charged $1.00 per minute for each minute
past 6:00pm.
____ If my child does not attend Grace Lutheran during the school year, I must have an updated
physical and immunization form before starting the summer program (PS2 – PK4 only).
____ If my child does not attend Grace Lutheran during the school year, I must provide a 1”
thick, impermeable, nap mat.
____ My child’s sleep mat must be kept in good condition. If it rips, a new one will be provided
and a $12.00 fee will be charged to you. (PS2 – PK4 only)
____ My child’s linens must be taken home every Friday to be washed. (PS2 – PK4 only)
____ Lunch orders are due 1 week in advance.
____ If your child becomes ill or is in need a change of clothes, parents must come to the school
within one hour.
____ Parents are to inform the school office of any and all problems or concerns.
Read and signed in Winter Haven, Florida this _______ day of ______________ 2015.
__________________________________________________
Parent Signature
CAMP SESSIONS
(Please circle the days that your child will be attending)
June 4 and 5 – NO SCHOOL, NO CHILDCARE
June 8-12:
M
T
W
TH
F
June 15-19: Vacation Bible School
M
T
W
TH
F
June 22-26:
M
T
W
TH
F
June 29-July 2 (closed July 3):
M
T
W
TH
July 6-10:
M
T
W
TH
F
July 13-17:
M
T
W
TH
F
July 20-24:
M
T
W
TH
F
July 27-31:
M
T
W
TH
F
August 3-7:
M
T
W
TH
F
August 10-14:
M
T
W
TH
F
August 17-18: CLOSED
August 19: First Day of School
Parent’s Signature: _______________________________________
Date: _____________