GCA Summer Camp 2016 – Overview
Ages: Preschool to 6th Grade
Registration Fee: FREE if registered by May 2nd; $15 per week if registered after May 2nd.
Tuition Fee: $125 per weekly session.* This includes up to 8 hours per day. You will need to
sign your child in and out every day. If time exceeds 8 hours for the day, an extended
care fee of $4.00 per hour will be charged, calculated to the next half hour. Extended
care payments are due weekly. *There are three weeks that the tuition fee will be
cheaper. See the registration form.
Camp Hours: From 7am to 6pm. Sessions will run Monday through Friday each week
(exception: Week of June 27 will be Mon-Thurs and Week of July 4 will be Tues-Fri).
PS-KG students have nap time in the afternoon (Parents must provide a small pillow, small
sheet and small blanket for nap-time).
Sessions Themes:
Session 1: June 6-10
Agency D3
Session 2: June 13-17 Colossal Coaster World
Session 3: June 20-24 Treehouse
Session 4: June 27-30 Scavenger Hunt - *No camp July 1
Session 5: July 5-8
Journey Off the Map - *No camp July 4
Session 6: July 11-15 Cactus Canyon
Session 7: July 18-22 VBS Week: Submerged! (Free VBS in morning, Fee for afternoon)
Session 8: July 25-29 Cave Quest
Activities will include:
• Bible teaching/worship
• Music/Drama
• Missions
• Outdoor activities/Recreation
• In-house movie day once a week
• Swimming once a week (water activites @ GCA for PS-KG)
• Arts/crafts
Lunches/Snacks: Morning & afternoon snacks will be provided by the camp. Lunches are to
be provided by the parents. Please provide a lunch that does not need refrigeration.
Microwaves will be available.
GCA Summer Camp – Registration Form
Student Name:
______________________________Grade Entering: ____________
TUITION & FEES INFORMATION:Please mark the sessions your child will attend camp. If registering after May 2nd, the registration fee is due at the time of registration. The weekly tuition payment is due on or before first day of new session or may be paid in advance.
Sessions are available for “walk-in” only on a limited basis. Register for all sessions needed in order to guarantee a spot. (Extended Care available for at the rate of $4.00 per hour.)
Registration Fee Dates: Theme Before
May 2 After May 2
Tuition Total
_______ Session 1 June 6-10 Agency D3 FREE _____ $15 $125 __________
_______ Session 2 13-17 Colossal Coaster
World FREE _____ $15 $125 __________
_______ Session 3 June 20-24 Treehouse FREE _____ $15 $125 __________
_______ Session 4 June 27-30 Scavenger Hunt (4 day week) FREE _____ $15 $100 __________ _______ Session 5 July 5-8 Journey Off the Map (4 day week) FREE _____ $15 $100 __________
_______ Session 6 July 11-15 Cactus Canyon FREE _____ $20 $125 __________
_______ Session 7 July 18-22 Submerged! VBS Week: FREE _____ $15 $78
*
_________________ Session 8 July 25-29 Cave Quest FREE _____ $15 $125 __________
Reg Fee Paid Total
* The week of July 18-22 is VBS week, which is sponsored by Dorsett Village Church. VBS takes place from 9:00 am to 12:00 noon – this portion of the day is free of charge. If your child is going to stay past 12 pm during this week, the camp Tuition fee of $78 and registration fee (if registered after May 2) of $15 will apply. Extended care fees will apply for any child at GCA for more than 8 hours.
AMOUNT PAID AT REGISTRATION _____________________ BALANCE DUE ___________________ I will bring my child to camp at approximately ______________a.m. & pick up at approximately ____________ p.m. Parent/Guardian __________________________________________________________ Date _____________________
Grace Christian Academy
GCA Summer Camp – Registration Form
Child’s Name ____________________________________________________________ M or F (please circle) Grade Entering _______________ Date of Birth ____________________
Address ___________________________________City________________________ State____ Zip _________
Father’s Name _____________________________________ Place of Employment _______________________________ Address (if different) ___________________________________City________________________ State____ Zip _________
Home Phone __________________________Wk Phone _________________________ Cell ________________________ Email ________________________________
Mother’s Name ____________________________________ Place of Employment _______________________________ Address (if different) ___________________________________City________________________ State____ Zip _________ Home Phone ____________________________Wk Phone _________________________ Cell ______________________ Email __________________________________
EMERGENCY INFORMATION:
Person(s) to be notified when parents cannot be reached:
Name/Relationship __________________________ Home #______________ Work #______________Cell ____________ Name/Relationship __________________________ Home #______________ Work #______________Cell ____________ Family Doctor ______________________________________________ Phone # _________________________________ Family Dentist ______________________________________________ Phone # _________________________________ Person(s) authorized to pick up/check out student: - must have identification before child can be released.
Name/Relationship ____________________________ Drivers Lic # ________________________Phone ______________ Name/Relationship ____________________________ Drivers Lic # ________________________Phone ______________ Name/Relationship ____________________________ Drivers Lic # ________________________Phone ______________
IMPORTANT: Current immunization records are required for your child before he/she may attend
Summer Camp.
Grace Christian Academy
GCA Summer Camp – Statement of Cooperation
Please carefully read the following Statement of Cooperation:1.
I/We support the Vision, Mission, Philosophy, Bible teaching, beliefs and objectives of Grace Christian Academy/GCA Summer Camp and will not refute them in my home or in the presence of my child.2.
I/We will support my child’s teacher/camp leader and understand that he/she has full discretion in the classroom discipline of my child.3.
I/We agree to be responsible for payment of all tuition, after care charges and fees. I/We understand that all tuition and fees must be paid in full by the beginning of the next session. Failure to comply will result in the student(s) not being allowed to attend the other summer sessions until the account is current. If account is ONE week late there is a $10 late fee assessed. If account is TWO weeks late, a $25 late fee will be assessed. If account is THREE weeks late, a $50 late fee will be assessed and student(s) will not be allowed to begin school in the fall until account is made current.4.
I/We agree to be financially responsible for any loss of/or damage to school/camp property that the student incurs during the camp sessions.5.
I/We give permission for the student to take part in all camp activities, including sports and camp-sponsored trips away from the school premises, and absolve the school, camp, or driver from liability to me/us or to the student because of any injury to the student at camp or during any camp activity.6.
I/We will support and take the side of the staff member in front of the student. If I/We have a problem with a particular staff member, I/We will follow the Biblical principle of going directly to that staff member (Matthew 18). If still not satisfied, I/We will then approach the Director or if necessary, the school administrator, but I/We will refrain from discussing it with others.7.
I/We agree with the camp’s right to dismiss any student when the student or their parents/guardians do not respect its standards or cooperate in the education process. I/We understand if the student(s) and parents/guardians are found to be out of harmony with the Grace Christian Academy/GCA Summer Camp ideals of work and life, they may be requested to withdraw whenever the general welfare demands it.8.
I/We give permission to the administration to take whatever steps necessary to obtain emergency medical care. I/We understand that an attempt will be made to contact me/us or a person listed on the health form. I/We understand that the student may be taken to a physician or the Emergency Room at DePaul Hospital and that I/We are responsible for any expenses incurred.9.
I/We give permission to use the student’s picture/voice/name in GCA/GCA Summer Camp promotional and communication materials such as newsletters, website, videos, flyer, etc.Pictures - Yes ☐ No ☐ Voice/Video - Yes ☐ No ☐ Name - Yes ☐ No ☐ I HAVE READ, UNDERSTOOD AND AGREE TO ABIDE BY THIS STATEMENT OF COOPERATION. ________________________________________________________ _________________________
Parent/Guardian (both parents signatures required) Date
________________________________________________________ _________________________
Parent/Guardian (both parents signatures required) Date
________________________________________________________ _________________________
Grace Christian Academy
GCA Summer Camp – Medical Authorization Form
Parents/Legal guardians of minors are requested to complete this consent form and return it to the Grace Christian Academy office along with your child’s application. This form will assist the school in its efforts to provide for the safety of its students during school-sponsored activities. Thank you for your cooperation.
(Please print legibly and use black ink)
Date ___________________ Grade Entering __________
Student’s Name ___________________________________________________Birth Date __________________________________ Address ______________________________________________City____________________________ State_____ Zip _________ Home Phone # __________________________ Physician ____________________________ Phone #_________________________ Father’s Name ___________________________________Work Phone # _____________________ Cell #_____________________ Mother’s Name __________________________________Work Phone # _____________________ Cell #_____________________ Emergency Contact _______________________________Work Phone # _____________________ Cell #_____________________ Emergency Contact _______________________________Work Phone # _____________________ Cell #_____________________ Emergency Contact _______________________________Work Phone # _____________________ Cell #_____________________
STUDENT MEDICAL INFORMATION/SPECIAL INSTRUCTIONS
List allergies to drugs, foods and plants: ___________________________________________________________________________ ____________________________________________________________________________________________________________ List regularly taken medications: _________________________________________________________________________________ List physical disabilities or medical conditions that may prevent student from participating in normal to rigorous activity:
____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Other special instructions: ______________________________________________________________________________________
TRANSPORTATION RELEASE – MEDICAL CONSENT/CERTIFICATION
Should it be necessary for my child to be transported in a Grace Christian Academy vehicle, a GCA staff member’s or volunteer’s vehicle, I do hereby agree to hold the staff member, volunteer and/or Grace Christian Academy blameless of any liability arising from injury, accident or damage. I also release and further discharge Grace Christian Academy and its staff and volunteers and its respective successors, heirs, assigns, agents, officers, directors, shareholders and servants, and all other persons, firms and corporations from any injury, accident or damage whatsoever caused to any person, firm or corporation, from and against all loss, reasonable counsel fees, expenses and liabilities incurred on or about any such claim, action or proceeding brought thereon, which I may now have or hereinafter assert against Grace Christian Academy and /or its staff or volunteers with respect to my riding in the school’s vehicle, or staff or volunteer’s vehicle, or arising from any injury, accident or damage whatsoever cause to any person, firm or cooperation. I, as the parent/legal guardian of the above named student hereby consent to the participation of my child in all of the activities of Grace Christian Academy, including field trips/outings, camp, swimming, boating, hiking, sporting events and any other activities customarily associated with the school. Furthermore, I certify that my child is physically fit and adequately trained to participate in such events. I also authorize Grace Christian Academy and its staff members or volunteers to consent for any necessary medical treatment should I be unavailable to authorize said treatment. I agree to be financially responsible or any charges incurred for the necessary treatment of my child. I do understand that the adult supervisors reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child.
______________________________________________________________________ _________________________
Parent/Guardian Signature Date
______________________________________________________________________ _________________________
Grace Christian Academy
GCA Summer Camp – Medication Administration Authorization
Date________________ Student’s Name________________________________________________________ Dear Parents,The following “over the counter” medications may be given to your child with your written permission. ALL OTHER “OVER THE COUNTER” medications will not be given unless the parent provides the medication along with a Request for Medication Form. All PRESCRIPTION medications must be in their original containers with a current script in order to be given at school. Medications brought from home MUST be given directly to the office staff by an adult. Students are not allowed to handle or transport medications. Please notify the office of a change in your student’s health or prescriptions.
Thank you for your cooperation. Print legibly and use black ink.
Grace Christian Academy has my permission for the Summer Camp Staff to administer medication to my child.
Student’s Name_______________________________________________ Grade_________ Age________ Weight___________ Allergies ________________________________________________________________________________________________ Please indicate which medications are approved and the amount to be given:
☐ Acetaminophen (Tylenol) Dose
Children’s chewable (80 mg per tab) Children’s Liquid (160 mg/5 mL)
1 tsp = 5 mL
Regular strength (325 mg per tab) Extra Strength (500 mg per tab) ☐ Ibuprofen (Motrin, Advil)
Children’s chewable (100 mg per tab) Children’s liquid (100 mg/5 mL)
1 tsp = 5mL
Regular (200 mg per tab) ☐ Tums
☐ Chloraseptic ☐ Cough Drops ☐ Benadryl
Children’s chewable (12.5 mg per tab) Children’s Liquid (12.5 mg/5 ml)
1 tsp = 5 mL
Regular (25 mg per tab)
It is understood that the medication is administered solely at the request of and as an accommodation to the undersigned parent or guardian. In consideration of the acceptance of the request to perform this service by any Grace Christian Academy designee, the undersigned parent or guardian hereby agrees to release Grace Christian Academy and designee from any legal claims, which they now have, or may thereafter have, arising out of the administration of or failure to administer the medication to the student.
__________________________________________________________________________ _________________________
Parent/Guardian Signature Date
__________________________________________________________________________ _________________________
