Summer Camp Registration Form Step 1 of 3 - Child Registration Information 33% URLThis field is for validation purposes and should be left unchanged.Child's Name(Required) First Last DOB:(Required) MM slash DD slash YYYY Program (Please Check One)(Required)Please select the program you're child will be grouped with. View Program Rates Little Explorers (Current 2 year old class) Explorers (Current 3 year old class) Mighty Explorers (Current VPK class) Senior Explorers (Current Kindergarten, 1st & 2nd graders) Check Your CampsPlease check the camps you'd like your child to attend. View Camp Themes Super Hero's World (June 1-5) Camping Adventure (June 8-12) Carnival Time (June 15-19) Safari Adventure (June 22-26) Stars & Stripes (June 29 - July 2) Step Into Space! (July 6-10) Lights, Camera, Action! (July 13-17) Sports Week (July 20-24) Financial Policy I agree and understand that I will be responsible to pay tuition for the week(s) my child is signed up for summer camp. My Brightwheel account will be charged May 2nd for June camp sessions and June 1st for July camp sessions. Registration fee and tuition are non-refundable.Parent's Initials(Required)Lunch Plan Parents must agree to bring a nutritious lunch and snacks in a lunchbox with an ice pack daily with the child's name printed clearly. Please send a filled water bottle with your child daily. Candy is only permitted during special events.Parent's Initials(Required)Medications I understand medications will only be given to my child with the proper authorization form. Prescription medications must have a prescription label in the original container and must be prescribed for my child.Parent's Initials(Required)Potty Training Policy I understand that CPS Early Academy requires all children who attend to be able to be able to use school lavatories with little or no assistance (not including current 2 year old class).Parent's Initials(Required)Playground Safety I grant my child permission to use all equipment and participate in all of CPS Early Academy Summer Camp activities. I will not hold Early Academy staff responsible for incidents beyond their control. I am responsible for my child's medical expenses in the event of an accident that results in an injury or illness that occurs with daily play opportunities.Parent's Initials(Required)Consent for Use of Photographs I hereby authorize and give full consent to Early Academy staff, teachers, and assistants to photograph my child(ren) during camp activities and events. I authorize and give full consent to Early Academy to publish and/or print my child's photograph. Photos may be used on bulletin boards, newsletters, websites, flyers and other materials used to promote our school.Parent's Initials(Required)Dress Code Policy No uniform is required to attend summer camp. All participants must come dressed daily in school-appropriate attire and wear closed-toe shoes. No sandals or flip-flops.Parent's Initials(Required)Discipline Policy I agree and understand that at CPS children are guided and directed in a positive, gentle manner. When dealing with a disruptive child, a teacher will always try to talk to and redirect that child. When a child is exhibiting harmful behavior, he/she may be asked to sit next to a teacher or by his/herself until he/she has gained control. Upon rejoining the group, the teacher will discuss with the child his/her behavior, why it is unacceptable, and a positive way to resolve the situation.Parent's Initials(Required)Parent's Name(Required) First Last Parent's Consenting Initials(Required)Parent's Email(Required) Parent's Contact Phone(Required) Primary Phone in Case of an Emergency(Required)Home Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent/Guardian Name(Required)Parent/Guardian Cell Phone(Required)Parent/Guardian NameParent/Guardian Cell PhonePerson(s) who will care for the child in case the parent/guardian cannot be reachedThese individuals may sign my child out (photo I.D. required). Click the (+) to add additional people.NameRelationshipPhone Number Add RemovePerson who may not legally contact or remove my child from schoolPlease provide legal documentationList all health problems and/or allergies(Required)(Food, Medication, Insects, ect.) Even if previously reported. If none, please put N/A.Physician Name(Required)Physician Phone(Required)Dentist Phone(Required)Dentist Name(Required)Parental Consent In case of an accident or serious illness, I want to be contacted by the school. If the school is unable to reach me, I hereby authorize the school to contact the physician or dentist indicated above and to follow his/her instructions. If it is impossible to contact this physician or dentist, the school will take whatever actions are necessary to provide care and treatment for my child, and exchange medical information with the provider as necessary to support the continuity of care for my child. I agree to pay all expenses incurred by the handling of the emergency care. In case of an accident or illness where immediate treatment of my child is not indicated, but where he/she is unable to remain at school, I request that one of the persons indicated above be contacted and requested to care for my child until I can be reached. Parent/Guardian e-Signature(Required)Date(Required) MM slash DD slash YYYY This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
