SUNRISE NEIGHBORHOOD YOUTH PROGRAMS
443O MANCHACA RD. AUSTIN, TX 78745
444-HOPE OR 444-3326
DAY CAMP REGISTRATION FORM
STUDENT'S NAME (indicate name used) ______
GRADE
STUDENT'S BIRTHDATE______/______/______MALE_____ FEMALE_____ COMPLETED______
PARENT/GUARDIAN 1 /PARENT/GUARDIAN 2
NAME
ADDRESS
CITY, ZIP
HOME PHONE
EMPLOYER/
WORK PHONE
PAGER/CELL #
CHURCH MEMBERSHIP______
PLEASE LIST NAMES AND PHONE NUMBERS OF PERSONS YOU HAVE AUTHORIZED TO DROP OFF OR PICK UP YOUR CHILD OR WHO CAN SERVE AS AN EMERGENCY CONTACT. WE WILL NOT RELEASE YOUR CHILD TO ANYONE WHO IS NOT LISTED BELOW.
NAME / HOME PHONE # / WORK PHONE #1.
2.
3.
4.
PLEASE CHECK THE WEEKS YOUR CHILD WILL ATTEND. (Please be accurate. We wish to serve as many families as possible. If you reserve a spot, you are responsible for payment for that week unless two week’s written notice is given to the Director so we may fill the spot from the waiting list.)
June 9 – 13 / June 16-20 / June 23-27 / June 30 –July 3 / July 7 - 11 / July 14-18 / July21-25 / July
28-Aug 1 / Aug 4 - 8 / Aug 11 - 15
PLEASE CHECK T-SHIRT SIZE:
YouthX-Small / Youth
Small / Youth
Medium / Youth Large / Adult
Small / Adult Medium / Adult Large / Adult X-Large
MEDICAL FORM/HEALTH HISTORY
STUDENT’S NAME______
SEX______DATE OF BIRTH______
FATHER’S NAME______
TELEPHONE HOME______WORK______
MOTHER’S NAME______
TELEPHONE HOME______WORK______
PHYSICIAN’S NAME______PHONE______
ADDRESS______
I verify that my child’s doctor has examined my child within the last twelve months and states that my child is able to participate in all activities of the program.
PARENT/GUARDIAN SIGNATURE______
Please indicate any reasons your child should be excluded from physical activities or their physical activities restricted.______
______
For your child’s safety and our knowledge, is your student a--
good swimmer fair swimmer non-swimmer
Does your child have allergies to--
Food Medications Insect Stings Poison Ivy or other Plants Other
Please provide details for any item checked______
______
Is your child currently being treated, or have they ever been treated for any of the following:
Asthma Diabetes Epilepsy/seizure disorder Heart trouble
Frequently upset stomach Physical handicap
Specifics______
______
Does your child wear Glasses Contact lenses
Does your child take any medications regularly? ______If so, what are they?______
______
Note: If medications will be taken at Sunrise, a separate medication form must be completed.
(Please complete other side)
5. Please list any additional medical information you feel we might need in order to insure this student’s safe participation in our program.
6. My child’s immunizations are up to date and a copy of them is on file at
______
Name of School Telephone
(If immunization records are not on file at any school, a copy of current immunization records must be submitted along with this medical form.)
EMERGENCY MEDICAL ATTENTION INSTRUCTIONS
______
Medical/health insurance company Insurance Policy Number
______
In case of emergency, first person to notify Telephone Number Relation to minor
Any additional information regarding my child’s health that a doctor should know:
______
______
In the event of an urgent medical emergency, I authorize Sunrise Community Church to take my child to the nearest medical facility available. I understand that Sunrise Community Church has an arrangement with South Austin Hospital and that it will be the facility of first choice because of the close proximity to the camp and the prior arrangement this facility has with Sunrise Community Church.
Parent’s Signature______
PERMISSION AND WAIVER RELEASE FORM
The staff of the Sunrise Neighborhood Youth Program takes every precaution to make all activities as safe as possible. HOWEVER, by its nature participation in supervised athletic and similar activities includes a risk of injury which may range from minor to long term catastrophic. Although serious injuries are not common in a supervised program, it is possible to minimize, not eliminate, this risk.
Participants can and have the responsibility to help reduce the chance of injury. PARTICIPANTS MUST OBEY ALL SAFETY RULES AT ALL TIMES.
Please read and complete the following consent and release form for the added protection of your child. This form must be accepted in its entirety-crossing through items is not acceptable. If you have questions regarding particular items, please consult the director prior to signing and submitting this form.
I hereby give my consent to Sunrise Neighborhood Youth Program to provide transportation for my child on field trips and other excursions conducted by and supervised by the Sunrise Neighborhood Youth Program staff. I understand that said transportation may be by charter bus, Sunrise vehicles, private vehicles or city bus. I may ask for details on a particular field trip’s mode of transportation if I desire.
The SNYP summer program includes swimming. During the summer, all children will go to the pool at scheduled times each week. I give_____ do not give_____ my permission for my child to use the diving board at the pool. I understand that the pool depth at the diving board is 10 to 15 feet. I certify that my child is able to swim well enough to be in this depth of water without problems.
I, ______, binding my heirs, executors, administrators, estate, and assigns, do hereby release and agree not to hold liable Sunrise Community Church, its officers, agents and employees, from any and all actions, causes of action, claims, demands, costs, or damages as a result of property damage or personal injuries sustained by myself, my child/children, or my property arising from or resulting from any act of omission or otherwise of Sunrise Community Church, its officers, agents and employees while participating in the Sunrise Neighborhood Youth Program.
I further release Sunrise Community Church, its officers, agents, and employees from all liability for personal injury resulting from my child’s failure or the failure of other participants in the activity to obey safety regulations and directions of the activity leader in good faith, in response to emergencies and exigencies which occur during the activity; provided, however that nothing contained herein shall excuse any employee of Sunrise Community Church or person assigned to be an activity leader by an employee of Sunrise Community Church, from the responsibility to act with reasonable care for my child’s safety during the course of the activity appropriate to the circumstances.
I hereby authorize Sunrise Community Church to consent to emergency medical or dental treatment for my child while my child is a participant in the Sunrise Neighborhood Youth Program. I understand that Sunrise Community Church will make all reasonable efforts to contact me and provide me with notice in the event that my child requires emergency medical or dental treatment. In the event that Sunrise Community Church cannot contact me and give me notice, I understand that I am hereby authorizing Sunrise Community Church to consent to such treatment on my behalf. I understand that Sunrise Community Church will seek necessary emergency treatment for my child only in the event my child is injured or harmed while engaged in a program or activity sponsored by Sunrise Community Church.
(Please continue on the other side.)
Please read and initial each of the following statements.
1.______I have received and read a copy of the program policies for the summer camp. I have discussed the policies with my child.
2.______I understand that the discounted fee of $90.00/week must be paid no later than 6:00 PM on the Thursday before each week’s session. I understand if payment is made on Friday, the fee is $100.
3.______I understand that the camp’s last week ends on August 15.
4.______I understand that there is a late fee for any occasion when I pick my child up after 6:00 pm. This fee is $5.00 for the first 10 minutes and $1.00/minute after that. The fee is due when I arrive at the center and is to be paid directly to the staff member who stayed late to watch my child.
5.______I understand that if my child is going to be absent on any day, I need to leave a message with the camp office by 10:00am. I also understand that if my child is going to arrive or leave in the middle of the day, it is my responsibility to verify in advance where the group will be and make arrangements to sign in or sign out my child at times that don’t conflict with field trips and swimming. (Children may NOT wait in the office for parents to pick them up when their group is going on an outing.)
6.______I am aware that the Sunrise Neighborhood Youth Program is an outreach program of Sunrise Community Church and that I may receive mailings and other contacts from the church. I am also aware that photographs taken of camp activities may be included in church publications.
7.______I understand that I must give two weeks notice in writing if I am withdrawing my child from any week they are enrolled in. If I give less notice, I will still be responsible for the fees for that week unless the director has been able to fill the spot from the waiting list.
8.______I understand that I am to provide a lunch with a drink and TWO snacks each day for my child. If my child does not bring a lunch or snacks, a staff member will purchase it at the store and I will need to pay for it that evening.
9.______I understand that my child is not to bring anything of value to camp, including money, video games, trading cards, etc. Sunrise Community Church is not responsible for items brought to camp and lost.
I agree to the above and to the program policies I have received.
Name of Child______
Signature of Parent/Guardian ______Date______
Received by______Date______
(Staff member’s signature)
Sunrise Neighborhood Youth Programs
"Son-sational" Summer Day Camp
Welcome to the Summer Day Camp Program of the Sunrise Neighborhood Youth Programs (SNYP). The SNYP is an outreach ministry of Sunrise Community Church, serving the children of our community by providing low-cost, high quality care during the summer.
Please take time to read our policies and to discuss them with your child.
IMPORTANT NOTES:
1. Registration fees and first week's tuition (total of $120.00/child) are due with completed paperwork in order to enroll your child. These fees are non-refundable if your child does not attend. If you obtained this packet from the website, please note that the forms must be printed out and returned with original signatures. WE CANNOT ACCEPT APPLICATIONS THROUGH EMAIL. WE CANNOT ACCEPT APPLICATIONS BEFORE APRIL 10.
2. Please be accurate in the weeks you sign up to use. You are responsible financially for all weeks you sign up for unless written notice is given to the Director, Sharon Ryan, at least two weeks in advance.
Parents and children are invited to meet the director and staff on Wednesday, May 28 at 6:00 pm. We will discuss policies and have the first week’s schedule ready.
On behalf of Pastor Tom Dykman and the members of our congregation, we would also like to invite you to join us for worship and Sunday School. Our worship services are Sunday morning at 10:00 with children’s programs during the service, and classes for all ages immediately following the service. We have a number of other programs that might be of interest to you, and we would love to share them with you. Please feel free to ask about our other programs for children, older youth, men's and women's groups and family activities.
We hope Sunrise will be a place you can feel welcomed as a part of the Lord's family. We look forward to a great summer and to meeting old friends and making new ones. Thank you for sharing your precious gifts—your children—with us.
Sharon Ryan, Director
SUNRISE NEIGHBORHOOD YOUTH PROGRAMS
SUMMER DAY CAMP
POLICIES 2008
PHILOSOPHY
The purpose of the Sunrise Neighborhood Youth Programs (SNYP) is to provide safe, low-cost, organized recreational and social activities for the school-aged child in a Christian atmosphere. It is our desire to provide the best care and positive learning experiences for each child by creating an environment where your child feels loved and accepted by God and others. We feel each child is a unique individual and we will strive to develop positive self-concepts and a sense of belonging. Our materials and activities are designed to promote growth in social, physical, spiritual and cognitive development.
We want each day to be a happy and fun-filled day, where your child will feel safe and secure. We will strive to work together with you to promote the healthy growth of your child.
ADMINISTRATION
The Director of the program is Sharon Ryan. The Director reports directly to Pastor Tom Dykman and to the Sunrise Servant's Council when requested.
DATES/HOURS
The Summer Day Camp consists of weekly sessions beginning June 9 and continuing until August 15. The hours are Monday – Friday from 7:00am to 6:00pm. The camp is held at Sunrise Community Church, 4430 Manchaca Rd.
AGES
The SNYP provides activities for the school-aged child age five through completing the sixth grade. Youth who have completed the sixth grade and above are also eligible to apply for our junior counselor program. You can speak to Sharon for details about the junior counselor program.