SUMMER CARE 2017
Grace Christian Academy
Application for Enrollment
Participant’s Name: ______Birth Date: ______/______/______
Parent/Guardian Contact Information (Cell/text) During the Day – BEST NUMBER TO REACH:
Father: ______Mother ______Guardian______
Whom shall we notify if we are unable to reach the mother, father, guardian, above? (Give name, phone # & relationship to the child):
Name/Phone #: ______Relationship to the child: ______
List any handicaps or allergies for your child:______
EMERGENCY TRANSPORTATION:
_____ Yes _____ No If unable to contact a parent, I authorize the Summer Care Staff to transport the injured child by car or
ambulance to the nearest medical facility.
FIELD TRIP PERMISSION TO LEAVE CAMPUS:
*I understand that the Summer Care attendees may leave the school grounds for an event and the Summer Care Staff may be driving the attendees. I release the Summer Care Staff from any liablility that may occur.
*Signature of Parent or Guardian: ______Date: ______/______/______
WEEKS/TIMES SUMMER CARE AVAILABLE: (List days needed for each week & time frame):
Monday, June 5 – Friday, June 9 (7:30 a.m. – 6:00 p.m.) ______
Monday, June 12 – Friday, June 16 (7:30 a.m. - 6:00 p.m.) ______
Monday, June 19 – Friday, June 23 (7:30 a.m. – 6:00 p.m.) ______
Monday, June 26 – Friday, June 30 - Bible Camp from 9:00-noon
(Summer care available only from 12:30 p.m. – 6:00 p.m.) ______
***No Summer Care the week of July 3 – July 7***
Monday, July 10 – Friday, July 14 (7:30 a.m. – 6:00 p.m.) ______
Monday, July 17 – Friday, July 21 (7:30 a.m. – 6:00 p.m.) ______
Monday, July 24 – Friday, July 28 (7:30 a.m. – 6:00 p.m.) ______
Monday, July 31 – Friday, August 4 (7:30 a.m. – 6:00 p.m.) ______
Monday, August 7 – Friday, August 11 (7:30 a.m. – 6:00 p.m.) ______
In the spaces above, please indicate by all applicable weeks which days during that week you would like Summer Care for your child. Please list an approximate drop off and pick up time. Thank you!