2014 Registration Packet
7600 S.W. 104 Street
Miami, Florida 33156
Phone: 305.667.0343
www.kendallchurch.org
Pastor, George Lutz
Preschool Director, Dr. Joy Galliford
License # C11MD0541
Welcome to Camp Mustard Seed, an action-packed,
Bible-based camp serving children 12 months – Grade 5
Our Camp Mission
Kendall United Methodist Church Camp Mustard Seed is a place where staff,
together with parents and the church, will provide a positive and trusting educational environment that
nurtures the healthy growth of the whole child as we strive to know Christ, serve Christ and share Christ.
Camp Calendar
Camp Mustard Seed is a nine-week program from June 16 - August 15, 2014. Our summer themes
include:
Session A:
Week 1:
Week 2:
Week 3:
Week 4:
Week 5:
Week 6:
June 16 - 20: Fun with the MBA
June 23 - 27: Fun with Dinosaurs
June 30 - July 3: Fun with God’s Universe
July 7 - 11: Fun with the World Cup
July 14 - 18: Fun with Numbers
July 21 - 25: Fun with Letters (A-M)
Session B:
Week 7: July 28 - August 1: Fun with Letters (N-Z)
Week 8: August 4 - 8: Fun with Jesus
Week 9: August 11 - 15: Fun Celebrations around the world
Camp Activities
All morning campers who participate in Session A will enjoy various crafts and activities. ( Activities
may include magic show, my gym, yoga etc.)
Afternoon camp activities for Session A and B include Bike Day on Mondays, water play (including
pools, slides and sprinklers) on Tuesdays and Thursdays, science on Wednesdays and the bounce house
will arrive every Friday. We will also have movie day one afternoon a week (popcorn will be served).
Week 1: Fun with the MBA will include an hour of basketball each day with the Hoop Dreams program.
There will be an extra fee of $50.00 for participants.
Week 4: Fun with the World Cup will include an hour of soccer each day with the Goal Dreams program.
There will be an extra fee of $50.00 for participants.
Camp Mustard Seed will be closed for the July 4th holiday.
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Enrollment Opportunities
Session A
1)
2)
3)
4)
5)
Quality Extended Care (QEC) from 7:00 - 9:00 am
Morning Camp from 9:00 am - 12:00 pm
Extended Camp from 9:00 am - 3:00 pm
Full Day Camp from 9:00 - 6:00 pm
Quality Extended Care (QEC) Drop-In Program from 12:00 - 6:00 pm. The QEC Drop-In
Program offers parents a flexible schedule between the hours of 12:00 - 6:00 pm.
Session B
Flexible Camp (Weeks 7, 8 and 9) offers parents a flexible schedule any day between the hours
of 7:00 am - 6:00 pm. You may drop-in/pickup at your convenience.
Available Camp Payment Plans
A non-refundable registration fee of $25.00 per child is required at the time of camp registration for either
session. Camp payment plans are available on a weekly basis for Session A. No credits will be given for
the days your child does not attend camp. If you are attending Session A, camp payment must be received
on the Friday prior to the upcoming week. For those participating in Session B (Flexible Camp), payment
is due on the last day of camp attendance. All Quality Extended Care balances must be paid at the close
of the camp week.
Late Fees
Any unpaid balance will incur a $10 late fee if not received by the close of the following Monday. A late
fee of $25 will be assessed for any outstanding balance of more than one week (from the Friday it was
due).
Camp Registration
Hours Enrolled
Morning QEC
Morning Camp
Extended Camp
Full Day Camp
Afternoon QEC/Drop-In
Flexible Camp
Hoop Dreams
Goal Dreams
7:00 am - 9:00 am
9:00 am - 12:00 pm
9:00 am - 3:00 pm
9:00 am - 6:00 pm
12:00 pm - 6:00 pm
7:00 am - 6:00 pm
9:15 am - 10:15 am
9:15 – 10:15 am
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Payment
$5 per day
$95 per week
$145 per week
$155 per week
$5 per hour
$5 per hour
$50.00 per week
$50.00 per week
Behavior Management
The goal of our camp behavioral management policy is to establish and maintain a safe and positive
environment so that all children can learn and grow in a positive and trusting educational setting.
Through clear and consistent rules, teachers will promote positive guidance and discipline techniques. All
staff will encourage children to take responsibility for their own actions, respect people and property, and
cooperate with one another.
Aggressive physical behavior toward staff or children is unacceptable. Staff will intervene immediately if
a child becomes physically aggressive. Positive guidance, including encouraging positive behavior, will
be the first technique for managing a challenging or disruptive child. In addition, staff may:
• Separate the children involved
• Immediately comfort the injured child and care for any injuries
• Notify parents or legal guardians of children involved in the incident
• Complete an incident report to be signed by the parents or legal guardians of the children
involved
• Review the adequacy of caregiver supervision, appropriateness of facility activities, and
administer corrective action if there is a reoccurrence.
Staff are prohibited from using physical punishment, psychological abuse, humiliation, abusive language,
or the withdrawal of food. Physical restraint will only be used if necessary to ensure a child’s safety.
Situations may arise when the child may need to be removed from an activity for a short period of time.
If there is a situation that we are unable to resolve, we will contact you for your support. Should we be
unable to mutually resolve any behavior issues, we reserve the right to remove your child from our
program to ensure the safety of all children and the staff.
Source: Model Child Care Health Policies – American Academy of Pediatrics, Pennsylvania Chapter
Medical Requirements
The Department of Children and Families (DCF) along with the Florida Department of Health require
each child attending Camp Mustard Seed to have a completed physical examination as well as
immunization record forms (DH-3040 & DH-680) on file in our Preschool. This information must be
submitted to the Preschool Office on or before the child’s first day of attendance in this program. School
age children, assuming that they are enrolled in a public or private educational institution are not required
to submit these health documents. Please be informed that all updated forms must be submitted on or
before the required date in the Preschool Office to continue your child’s participation in Camp Mustard
Seed. It is the parent’s responsibility to provide the KUMC Preschool office with all updated records.
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Required Forms:
1) Consent and Release Form
2) Section 65C-22(2), F.A.C., requires a current physical examination (Form 3040) and
immunization record (Form 680 or 681) by August 1, 2013 or within 30 days of enrollment.
3) Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility
Brochure, “KNOW YOUR CHILD CARE FACILITY”.
4) Section 65C-22.006(4)c2., F.A.C., requires that parents be notified in writing of the
disciplinary practices used by the child care facility.
5) F.D.C. requires that you acknowledge receipt of the brochure, “INFLUENZA VIRUS, THE
FLU, A GUIDE TO PARENTS”.
Your registration will be finalized when the following process has been completed:
1) Complete the Camp Mustard Seed Registration Form.
2) Attach a non-refundable registration fee of $25.00 per child along with the first week’s payment
3) Current physical examination form (Form 3040) and immunization record form (Form 680 or
681).
Kendall United Methodist Church reserves the right to suspend program participation due to nonpayment.
Withdraw Policy
If you are planning to withdraw your child from Camp Mustard Seed, written notification must be
submitted to the preschool office prior to his/her
absence.
KUMC Campus is a
nut-free facility.
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Camp Mustard Seed
Registration Form
Child 1:
_________________________________________________________________
_______________
CHILD’S FIRST / MIDDLE / LAST NAME
MALE/FEMALE
__________________________________________________________
______________________
NICKNAME
AGE
_____________________________________
DATE OF BIRTH
Registration Selection:
Session A
 Week 1 (June 16 - 22)
 Week 4 (July 7 - 11)
 Week 2 (June 23 - 27)
 Week 5 (July 14 - 18)
 Week 3 (June 30 - July 3)
 Week 6 (July 21 - 25)
Session B
 Week 7 (July 28 - Aug. 1)  Week 8 (Aug. 4 - 8)
 Week 9 (Aug. 11 - 15)
Registration Hours:
Session A
 Morning QEC (7:00 – 9:00 am)
 Extended Camp (9:00 am – 3:00 pm)
 QEC Drop-In (12:00 – 6:00 pm)
 Morning Camp (9:00 am – 12:00 p
 Full Day Camp (9:00 am – 6:00 pm)
Session B
 Flexible Camp (7:00 am – 6:00 pm)
Child’s Age/Grade (by Sept. 1, 2014):
 12 - 23 months
 Kindergarten
 4th Grade
 2 years old
 1st Grade
 5th Grade
 3 years old
 2nd Grade
 4 years old
 3rd Grade
Child 2:
_________________________________________________________________
_______________
CHILD’S FIRST / MIDDLE / LAST NAME
MALE/FEMALE
__________________________________________________________
_______________________
NICKNAME
AGE
6
____________________________________
DATE OF BIRTH
Registration Selection:
Session A
 Week 1 (June 16 - 20)
 Week 4 (July 7 - 11)
 Week 2 (June 23 - 27)
 Week 5 (July 14 - 18)
 Week 3 (June 30 - July 3)
 Week 6 (July 21 - 25)
Session B
 Week 7 (July 28 - Aug. 1)  Week 8 (Aug. 4 - 8)
 Week 9 (Aug. 11 - 15)
Registration Hours:
Session A
 Morning QEC (7:00 – 9:00 am)
 Extended Camp (9:00 am – 3:00 pm)
 QEC Drop-In (12:00 – 6:00 pm)
 Morning Camp (9:00 am – 12:00 p
 Full Day Camp (9:00 am – 6:00 pm)
Session B
 Flexible Camp (7:00 am – 6:00 pm)
Child’s Age/Grade (by Sept. 1, 2014):
 12 - 23 months
 2 years old
 3 years old
 4 years old
 Kindergarten
 1st Grade
 2nd Grade
 3rd Grade
 4th Grade
 5th Grade
Family Information:
___________________________________________
___________________________________________
MOTHER’S NAME
FATHER’S NAME
___________________________________________________________
___________________________________________________________
HOME PHONE
HOME PHONE
CELL PHONE
CELL PHONE
___________________________________________________________
___________________________________________________________
ADDRESS / CITY / STATE / ZIP
ADDRESS / CITY / STATE / ZIP
___________________________________________________________
___________________________________________________________
E-MAIL ADDRESS
E-MAIL ADDRESS
___________________________________________________________
___________________________________________________________
OCCUPATION
OCCUPATION
___________________________________________________________
__________________________________________________________
EMPLOYER
EMPLOYER
___________________________________________________________
___________________________________________________________
WORK PHONE
WORK PHONE
___________________________________________________________
___________________________________________________________
WORK ADDRESS
WORK ADDRESS
Custody:
 Mother
 Father
 Both
 Other
Describe:
__________________________________________________________________________________
__________________________________________________________________________________
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Medical and Emergency Information:
I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain
emergency medical care if warranted.
____________________________________
DOCTOR
____________________________________
PHONE
_____________________________________________________________________________________
ADDRESS / CITY / STATE / ZIP
_____________________________________________________________________________________
MEDICAL INSURANCE
____________________________________
POLICY #
____________________________________
GROUP #
_____________________________________________________________________________________
SUBSCRIBER NAME
_____________________________________________________________________________________
HOSPITAL PREFERENCE
Please list allergies, special medical or dietary needs, or other areas of concern:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Emergency Contacts:
Your child will be released only to the custodial parent or legal guardian and the persons listed below.
The following people will also be contacted and are authorized to remove the child from the facility in
case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be
reached.
__________________________
__________________________
__________________________
NAME
NAME
NAME
__________________________
__________________________
__________________________
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
__________________________
__________________________
__________________________
CELL PHONE
CELL PHONE
CELL PHONE
__________________________
__________________________
__________________________
HOME PHONE
HOME PHONE
HOME PHONE
__________________________
__________________________
__________________________
WORK PHONE
WORK PHONE
WORK PHONE
__________________________
__________________________
__________________________
ADDRESS
ADDRESS
ADDRESS
__________________________
__________________________
__________________________
CITY/STATE/ZIP
CITY/STATE/ZIP
CITY/STATE/ZIP
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Consent for Photography:
I consent to allow the taking of photos or videos of my child and/or me during program activities.
Photos/videos may reveal my child’s and/or my identity without any compensation paid to my child, to
me or to others. All photos and videos may be used for educational and/or promotional purposes.
I consent to allow photos of my child to only be used in the classroom.
Please mark one:
 Yes, I consent
 No, I do not consent
By signing below, you verify that you have received the above items and that all information on this
enrollment form is complete and accurate. For assistance completing this form, please contact
Kendall United Methodist Church Preschool at 305-667-0343. We look forward to caring for your
child and getting to know your family.
_____________________________________________________________ ____________________
PARENT / GUARDIAN SIGNATURE
DATE
________ I
understand that there will be no refund of the Registration Fee should I choose to
discontinue the enrollment process for 2014-15.
FOR OFFICE USE ONLY
Non-Refundable Registration Fee ($25 per child)
Camp Tuition - Week #_____________
Hoop Goals – Week 1
Goal Dreams – Week 4
Total
Current Amount Due
Balance
_________________ _____________
___________ ____________________________________
Application Submission Date
Check #
Amount Paid
Staff Signature
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CONSENT AND RELEASE FORM
I, the undersigned, as parent and/or legal guardian of __________________________________ (hereinafter
referred to as “my child”), hereby consent to my child participating in any and all activities at Kendall United
Methodist Church and assume all risks on behalf of my child associated with said activities. I hereby certify that my
child is mentally, emotionally, and physically able and capable of participating in all activities. If my child has any
condition(s), which may be relevant to a physician in the event of an emergency, I may be reached at the telephone
number listed below. If I cannot be reached, I hereby authorize an adult supervisor to contact 9-1-1 Emergency and
authorize emergency and non-emergency medical technicians and health care providers to assess the condition of
my child and render medical assistance and treatment as determined necessary by such medical technicians and
health care providers. If there are any activities that I do not want my child to participate in, I have listed them
below.
I hereby agree that the Church shall be completely absolved, released, indemnified, and held harmless from any and all
liability arising from or associated with any injury, death, obligation, liability, indebtedness, or other matter(s) of
whatsoever kind concerning or otherwise involving my child’s participation in all activities and/or any medical services
arising therefrom. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and
inclusive as permitted by the laws of the State of Florida, and that if any portion hereof is held to be invalid, it is
agreed that the balance and all remaining terms shall, notwithstanding, continue to be in full legal force and effect.
This release contains the entire agreement between the parties hereto and the terms of this release are contractual
and not merely a recital.
I HAVE CAREFULLY READ THE FOREGOING RELEASE, WAIVER AND INDEMNITY, KNOW THE
CONTENTS THEREOF, AND I HEREBY SIGN THIS RELEASE, WAIVER AND INDENITY OF MY OWN
VOLITION. I have been given an opportunity to discuss and review this document with an attorney of my choice,
fully understand the contents contained herein, and, thus, this documents shall not be construed against the drafter
hereof, or any parties hereto. This is a legally binding agreement which I have read and understand.
ACTIVITIES THAT I DO NOT WANT MY CHILD TO PARTICIPATE IN:
_____________________________________________________________________________________
_______________________________________________________________________________
TELEPHONE NUMBER WHERE I MAY BE REACHED IN AN EMERGENCY:
__________________________________________________________________________________________
__________________________________________________________
____________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN
DATE
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