Summer Camp Important Facts

Summer Camp Important Facts

Monday-Friday. 7:30 a.m. to 5:30 p.m.

Christian Atmosphere

Friendly Staff

Clean and Safe and Structured Environment

Safe and reliable transportation

Meals provided ...Breakfast, Lunch, & Snack

Curriculum:

Academic /Christian Enrichment (Bible, Math, Reading, Writing)

Arts /Crafts (Drawing, Painting)

Field Trips (Museums, Libraries, Bowling, Skating)

Team Building Activities, Music & Games

Registration Begins Now!!!

TM “New Birth” LCM Registration Form

Parents, This information is required by the Mississippi State Department of Health, and our Child Care Licensure Inspector. If the item is not applicable, then please answer NA. Please do NOT leave anything blank.A separate application is requiredfor each child....

Child’s Full Name: (First)______(Middle)______(Last)______

Date of Birth: ______M___ F___

Home Address: ______

City/State/ Zip: ______Home Phone: ______

School: ______Grade in Fall 2018: ______

Student Lives With (circle one): Mother *Father * Both Parents *Other

I heard about your program in (circle one):Previous Enrollment *Member *Flyer*Internet

*********************************************************************************

Family Doctor: ______Phone:______

Mother’s Name: ______E-Mail: ______

Work Phone: ______Cell Phone: ______

Father’s Name: ______E-Mail: ______

Work Phone: ______Cell Phone: ______

Emergency Contacts

Name: ______Relationship:______

Phone1:______Phone2:______

Name: ______Relationship:______

Phone1:______Phone 2: ______

The following people are authorized to pick up and drop off my child/children:

Name: _____________Name:______

Name: ______Name:______

Does your child have any allergies? ______Please list, including food if necessary ______

______

List any special needs your child may have: ______

______

Read and INITIAL the appropriate answer to the following items:

I have been informed that this Daycare Center does NOT provide liability insurance for my child: _____Yes _____ No

I have been given a copy of and have read the MSDH Regulation Summary for Parents: ______Yes ____No

Complete each of the following by circling either Yes or No:

My child may be photographed at the Aftercare: Yes No

This facility may give my child emergency medical treatment if needed: Yes No

******************************************************************************************

Parent Statement:
I understand that there is a $100 non-refundable registration/activity fee. I have read and fully understand the after care policies discussed in this handbook and I agree to adhere to these policies and procedures. T.M.N.B.L.C. Ministries Childcare Center reserves the right to refuse enrollment to students who demonstrate disruptive or unsafe behavior with no refund. I give authorization for T.M.N.B.L.C. MinistriesChildcare Center to use my child’s photograph in any future web or print advertisements. I understand my child’s full name will not be used. I give permission for my child to be transported by T.M.N.B.L.C. Ministries Childcare Center transportation ministry.

HAVING READ AND UNDERSTOOD THE PARENT STATEMENT PRINTED ABOVE, I SIGN THIS APPLICATION:

Parent’s Signature: ______Date:______

THE MILLER NEW BIRTH LIFE CHANGING MINISTRIES CHILDCARE CENTER PRAYS THAT YOU WILL HAVE A GREAT LEARNING EXPERIENCE.

******************************************************************************************

Director Signature: ______Date: ______

Record updated & signed by parent if no changes (once a year):

Signature: Date:

DIRECTOR USE ONLY:

Enrollment Date:___ /____ /____

Start Date:____/____/____

Withdrawal:____/____/____