Summer Day Camp Application
The Salvation Army Community Center — Dane County
Summer Day Camp Application The Salvation Army Community Center’s summer day camp is an eight week program that occurs this year from June 18 through August 10. We will provide educational and recreational activities all day long and serve breakfast, lunch, snack, and dinner. We will attend multiple field trips per week, including trips to museums, zoos, and trips to local beaches and parks. Please drop applications off at the Community Center office, mail or email applications to: [email protected] Program Enrichment Coordinator The Salvation Army of Dane County 3030 Darbo Drive Madison, WI 53714 Requirements for Participation: Children must be entering 1st-6th grade. ________ (initials) A fee of $20 dollars per week for 1 child, $30 for 2 children from the same household, $40 for 3+ children, must be paid weekly by Friday to pay for the following week of camp, monthly by the 1st Monday of the month, or in full by the 1st day of camp. The first week of camp must be paid by June 18.
1
My preferred method of payment is (please initial one) ______ Weekly ______ Monthly _____ In Full (10% Discount) Transportation: We attend off-site field trips multiple times per week. At the beginning of camp you will receive a schedule of field trips. For your child to attend summer camp, you must give permission for them to travel in The Salvation Army vehicles. Please sign below to grant permission. ____________________________________________________________________________________ Parent/Guardian Signature
Date Signed
Location and Time: The Salvation Army Community Center is located at 3030 Darbo Drive in Madison. Our summer day camp program runs 09:00 a.m. – 05:30 p.m. Monday through Friday with extended care available from 08:30 a.m.-06:00 p.m. for additional cost of $5.00 per week. Breakfast is served from 09:00 a.m. to 09:30 a.m., Lunch served 12:00p.m.-12:30p.m., Dinner served from 05:00p.m.05:30p.m. Family members are invited to eat dinner with the kids. _______ (initial) I need the extended care. Camp hours for my child will be 08:30 a.m. – 06:00 p.m. ______ (initial) I do not need the extended care. Camp hours for my child will be 09:00 a.m. – 05:30 p.m.
Child Information: Name: ________________________________________________________________________ First
Last
Nickname(s): _____________________________________________________ Birth date: _____________________________________ Age: ____________
Male
Female
Grade in the fall: ________________________________________ Does your child have allergies?
YES
NO
What kind of allergies does your child have? ___________________________________________________________ (We will be visiting and interacting with animals this summer. Please be sure to let us know if your child has any allergies to animals.) Does your child have food sensitivities or food restrictions?
2
YES
NO
What foods should your child NOT eat while at camp? ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ Can your child swim in the deep end of a pool?
YES
NO
Does your child have any special social, emotional or physical needs that camp teachers should be aware of? YES NO If yes, please explain below and call Ms. Krissandra (608-250-2275) to discuss how we can best support your child during summer camp.
If your child takes prescription medication during summer camp, please sign below to authorize administration. Parent/Guardian Signature: ______________________________________________________ Date Signed: __________________________________________________________________ Medicine, Dosage and time to Administer _______________________________________
Please place an “X” below the weeks of camp your child will be attending. If your child will be absent, please call ahead to excuse them: 608-250-2275 Week 1 June 18-22
Week 2 June 25-29
Week 7 July 30-August 3
Week 3 July 2-6 (no summer camp on July 4)
Week 4 July 9-13
Week 5 July 16-20
Week 6 July 23-27
Week 8 August 6-10
3 Please place an “X” below the weeks your child will be attending Army Lake Overnight Camp. Please call Captain Melinda or Captain Jacob at 608-250-2203 if additional information on these camps. Junior Camp June 12-16 Ages 9-12yrs.
Sports Camp Kids Camp July 2-6 July 9-13 Ages 9-12yrs. Ages 6-8yrs
Family Camp July 27-29 All Ages
Parent/Guardian Information: Main contact name: _____________________________________________________________ First
Last
Home phone number: ____________________________ Cell phone number: ______________________________ Work number: ___________________________________ Home address: ______________________________________________________________________________ ______________________________________________________________________________ Email address: __________________________________________________________________ Do you prefer mail or email communication from camp? Mail
Email
Additional Emergency Contacts:
4
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Is your child allowed to leave the program alone?
Phone Number YES
NO
If no, please list all additional persons (other than the main contact and emergency contacts) your child may leave with. Identification may be required to verify. ______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
Adults in your household ______________________________________________________________________________ First and Last Name
Relationship to Child
______________________________________________________________________________ First and Last Name
Relationship to Child
______________________________________________________________________________ First and Last Name
Relationship to Child
Children in your household (ages 0-17) _____________________________________________________________________________ First and Last Name
Relationship to Child
Age/Gender
______________________________________________________________________________
5
First and Last Name
Relationship to Child
Age/Gender
______________________________________________________________________________ First and Last Name
Relationship to Child
Age/Gender
Permissions: _____ (initial) 1. I give permission for The Salvation Army to seek and secure medical treatment/tests/admissions for my child in case of emergency. YES
NO
_____ (initial) 2. I understand that, should my child's behavior warrant it, my child may be suspended from the program for a period of time without reimbursement. I will be notified should suspension occur. YES NO
_____ (initial) 3. I give permission for The Salvation Army staff to apply sunscreen to my child. YES NO
____ (initial) 4. I give permission for The Salvation Army staff to apply insect repellant to my child YES NO
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_____ (initial) 5. I give permission and consent for my child to be photographed during camp session activities. I further give permission and consent that any such photographs may be published and used by The Salvation Army to illustrate and promote the camp experience and youth programming. YES NO _____ (initial) 6. I understand that, should my child's behavior warrant it, my child may not be allowed to go on field trip(s). I will be notified should this occur and my child may have to stay home from camp that day. YES
NO
Parent/Guardian Signature: ____________________________________ Date Signed: ________________________________________________ Check this box if you are interested in learning about volunteer opportunities at The Salvation Army Summer Day Camp
Summer Day Camp Application The Salvation Army Community Center’s summer day camp is an eight week program that occurs this year from June 18 through August 10. We will provide educational and recreational activities all day long and serve breakfast, lunch, snack, and dinner. We will attend multiple field trips per week, including trips to museums, zoos, and trips to local beaches and parks. Please drop applications off at the Community Center office, mail or email applications to: [email protected] Program Enrichment Coordinator The Salvation Army of Dane County 3030 Darbo Drive Madison, WI 53714 Requirements for Participation: Children must be entering 1st-6th grade. ________ (initials) A fee of $20 dollars per week for 1 child, $30 for 2 children from the same household, $40 for 3+ children, must be paid weekly by Friday to pay for the following week of camp, monthly by the 1st Monday of the month, or in full by the 1st day of camp. The first week of camp must be paid by June 18.
1
My preferred method of payment is (please initial one) ______ Weekly ______ Monthly _____ In Full (10% Discount) Transportation: We attend off-site field trips multiple times per week. At the beginning of camp you will receive a schedule of field trips. For your child to attend summer camp, you must give permission for them to travel in The Salvation Army vehicles. Please sign below to grant permission. ____________________________________________________________________________________ Parent/Guardian Signature
Date Signed
Location and Time: The Salvation Army Community Center is located at 3030 Darbo Drive in Madison. Our summer day camp program runs 09:00 a.m. – 05:30 p.m. Monday through Friday with extended care available from 08:30 a.m.-06:00 p.m. for additional cost of $5.00 per week. Breakfast is served from 09:00 a.m. to 09:30 a.m., Lunch served 12:00p.m.-12:30p.m., Dinner served from 05:00p.m.05:30p.m. Family members are invited to eat dinner with the kids. _______ (initial) I need the extended care. Camp hours for my child will be 08:30 a.m. – 06:00 p.m. ______ (initial) I do not need the extended care. Camp hours for my child will be 09:00 a.m. – 05:30 p.m.
Child Information: Name: ________________________________________________________________________ First
Last
Nickname(s): _____________________________________________________ Birth date: _____________________________________ Age: ____________
Male
Female
Grade in the fall: ________________________________________ Does your child have allergies?
YES
NO
What kind of allergies does your child have? ___________________________________________________________ (We will be visiting and interacting with animals this summer. Please be sure to let us know if your child has any allergies to animals.) Does your child have food sensitivities or food restrictions?
2
YES
NO
What foods should your child NOT eat while at camp? ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ Can your child swim in the deep end of a pool?
YES
NO
Does your child have any special social, emotional or physical needs that camp teachers should be aware of? YES NO If yes, please explain below and call Ms. Krissandra (608-250-2275) to discuss how we can best support your child during summer camp.
If your child takes prescription medication during summer camp, please sign below to authorize administration. Parent/Guardian Signature: ______________________________________________________ Date Signed: __________________________________________________________________ Medicine, Dosage and time to Administer _______________________________________
Please place an “X” below the weeks of camp your child will be attending. If your child will be absent, please call ahead to excuse them: 608-250-2275 Week 1 June 18-22
Week 2 June 25-29
Week 7 July 30-August 3
Week 3 July 2-6 (no summer camp on July 4)
Week 4 July 9-13
Week 5 July 16-20
Week 6 July 23-27
Week 8 August 6-10
3 Please place an “X” below the weeks your child will be attending Army Lake Overnight Camp. Please call Captain Melinda or Captain Jacob at 608-250-2203 if additional information on these camps. Junior Camp June 12-16 Ages 9-12yrs.
Sports Camp Kids Camp July 2-6 July 9-13 Ages 9-12yrs. Ages 6-8yrs
Family Camp July 27-29 All Ages
Parent/Guardian Information: Main contact name: _____________________________________________________________ First
Last
Home phone number: ____________________________ Cell phone number: ______________________________ Work number: ___________________________________ Home address: ______________________________________________________________________________ ______________________________________________________________________________ Email address: __________________________________________________________________ Do you prefer mail or email communication from camp? Mail
Additional Emergency Contacts:
4
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Is your child allowed to leave the program alone?
Phone Number YES
NO
If no, please list all additional persons (other than the main contact and emergency contacts) your child may leave with. Identification may be required to verify. ______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
______________________________________________________________________________ First and Last Name
Relationship to Child
Phone Number
Adults in your household ______________________________________________________________________________ First and Last Name
Relationship to Child
______________________________________________________________________________ First and Last Name
Relationship to Child
______________________________________________________________________________ First and Last Name
Relationship to Child
Children in your household (ages 0-17) _____________________________________________________________________________ First and Last Name
Relationship to Child
Age/Gender
______________________________________________________________________________
5
First and Last Name
Relationship to Child
Age/Gender
______________________________________________________________________________ First and Last Name
Relationship to Child
Age/Gender
Permissions: _____ (initial) 1. I give permission for The Salvation Army to seek and secure medical treatment/tests/admissions for my child in case of emergency. YES
NO
_____ (initial) 2. I understand that, should my child's behavior warrant it, my child may be suspended from the program for a period of time without reimbursement. I will be notified should suspension occur. YES NO
_____ (initial) 3. I give permission for The Salvation Army staff to apply sunscreen to my child. YES NO
____ (initial) 4. I give permission for The Salvation Army staff to apply insect repellant to my child YES NO
6
_____ (initial) 5. I give permission and consent for my child to be photographed during camp session activities. I further give permission and consent that any such photographs may be published and used by The Salvation Army to illustrate and promote the camp experience and youth programming. YES NO _____ (initial) 6. I understand that, should my child's behavior warrant it, my child may not be allowed to go on field trip(s). I will be notified should this occur and my child may have to stay home from camp that day. YES
NO
Parent/Guardian Signature: ____________________________________ Date Signed: ________________________________________________ Check this box if you are interested in learning about volunteer opportunities at The Salvation Army Summer Day Camp
