Sensational Kids Summer Camp by 5q0n3ur2


									Sensational Kids Summer Camp                                                                 Application 2011
__Our Lady of Hope                       ___ The Mary Louis Academy
Camper’s Name: _______________________________________________________________________________________ Age: ______
Date of Birth: _______________________ Sex: M___ F___            Home Phone: (     ) ____________________________________________
Camper’s Address: _______________________________________________________________________________ Apt.: ____________
City: __________________________________________________________ State: _____________________ Zip: ___________________
Camper’s School: _________________________________________________________________________ Grade:__________________
Mother’s Full Name: _______________________________________________________________________________________________
Mother’s Work #: (      ) _____________________________________ Place of Employment: ___________________________________
Mother’s Mobile #: (      ) ____________________________________ Email Address: _________________________________________
Father’s Full Name: _______________________________________________________________________________________________
Father’s Work #: (     ) ______________________________________ Place of Employment: ___________________________________
Father’s Mobile #: (    ) _____________________________________ Email Address: _________________________________________

Emergency Contact Person: _________________________________________________________________________________________
Relationship to Camper: ________________________________ Phone #: (              ) ______________________________________________

  Please check each of the weeks you plan on having your child attend. (MINIMUM 2 WEEKS)

                 ____ JULY 5       ____ JULY 11          ____ JULY 18   ____ JULY 25
                 ____ AUG. 1       ____ AUG. 8           ____ AUG. 15   ____ AUG. 22

        Kindercamp         Ages: 3 - 5 Only      ____ 5 Full Days       ____ 5 Half Days

        Junior Division          ____     Ages: 6 – 8 (or children who are 5 years old and have completed Kindergarten)

        Senior Division          ____     Ages: 9 – 14

Bus Service:
                 ____ No      ____ Yes ( ____ Round Trip $60.00 per week)         ( ____ AM Only or ____ PM Only $45.00 per week)
If Yes, please indicate cross streets.
Cross Streets: ___________________________________________________________________________________________________

       Having read all of the information in the camp application package, I agree to comply with all of the
requirements and procedures of the program as stated in the camp policy. I also give permission to authorize
emergency medical procedures if necessary. (PLEASE SEE ENROLLMENT AGREEMENT ON BACK OF
            ________________________________________________                         ____________________
                                 Parent or Guardian’s Signature                                                   Date

A $65.00 (non-refundable) deposit must be included with this application. Please make all checks payable to
“Sensational Kids”. Please do not mail cash.

Office Use Only                                                                            Mail to: Sensational Kids
Date Received: ____________________                                                                 110-64 Queens Blvd.
Fee: _____________________________                                                                  Suite 265
Comment: ________________________                                                                   Forest Hills, NY 11375
                               ENROLLMENT AGREEMENT
1. A $65.00 (non-refundable) registration fee must accompany all signed applications.
2. The medical form must be completed and signed before a child is allowed to attend camp. The medical
   form does not have to accompany the application form but must be on file prior to your child’s first
   day of camp. The camp reserves the right to dismiss any child without an up to date medical form on
   file. No refunds will be given.
3. In the event that a parent cannot be contacted, the parent gives permission to the hospital or doctors to
   administer emergency medical treatment to the child.
4. The parent gives consent for their child to take supervised trips.
5. The parent gives consent for use of their child’s photo by the camp.
6. The camp will not be put between feuding parents, and will permit both parents to have access to their
   child and will release the child to either parent unless a court order specifically directs otherwise. The
   camp reserves the right to dismiss a child from camp without a refund if either parent becomes
   disruptive or adversely interferes with the functioning of the camp office.
7. The camp reserves the right to terminate bus service in selected zip codes due to limited attendance, or
   if the camp deems it necessary.
8. The camp reserves the right to terminate this contract if the fees are not paid in full, for discipline or
   behavioral problems or if the camp deems it necessary.
9. There are no refunds for absences, withdrawals, changes or terminations.
10. Optional trips are based on a first-come, first-serve basis. Seats are limited for each trip and are not
11. The camp will not be held responsible for any lost, stolen or damaged personal property including toys,
    video games, trading card, cell phones, ipods, etc.
12. Any changes made to your original application will incur a $20.00 fee for each change.
13. Failure to maintain your payment schedule will result in a $20.00 late fee per month or a readjustment
    of the weekly rate.
14. A $20.00 fee will be charged for all returned checks. If this should occur, all remaining fees must be
    paid with a money order.
15. The parent has read and agrees to the camp policy and fees, bus service policy, and optional trip policy.

     ______________________________________________        ________________________
            Parent or Guardian’s Signature                          Date

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