2024 Summer Camp Registration

Camper's Information

*Camper's Name:

*Grade for Fall of 2024: —Please choose an option—1st2nd3rd4th5th6th7th8th9th

*Date of Birth:

*Gender: —Please choose an option—MaleFemale

*Shirt Size: —Please choose an option—Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult Extra Large

*School:

*Primary Residence/Mailing Address:

Church Home:

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Parent's Information

*Parent 1 Name:

*Parent 1 Cell Phone Number:

Parent 1 Work Phone Number:

Parent 1 Place of Work:

*Parent 1 Email Address:

*Responsible Party?:YesNo

Parent 2 Name:

Parent 2 Cell Phone Number:

Parent 2 Work Phone Number:

Parent 2 Place of Work:

Parent 2 Email Address:

Responsible Party?: YesNo

Other Persons Authorized for Pick Up (Name and Phone Number):

*Preferred/Best Method of Emergency Contact (check all that apply):
Parent 1 CellParent 1 WorkParent 2 CellParent 2 Work
Other:

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Medical Information

Allergies:

Medications your child takes on a regular basis and the dosages:

*Primary Care Doctor:

*Dentist:

Please provide any additional information about your child’s health history, behavior, physical, emotional, or mental health about which the summer camp staff should be aware.

If your child will need to take medication while in our care, please provide the name of the medication, the dosage, the time of administration, and any additional pertinent information.

Medication Authorization:
By checking this box, I am giving my permission for Augusta Road Baptist Church staff members to administer the above medication(s) and dosage(s) to my child.

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Attendance and Tuition

This year, children will have the option to be registered for 9 full weeks of Summer Camp or 5 full weeks of Summer Camp. A nonrefundable registration fee of $95 will be due at the time of registration to secure your child’s spot for both the 9 Week and 5 Week packages. Tuition will be drafted from the account you provide on the Tuition Authorization Form. This form can be found on the confirmation page after submitting registration form.

Hours: We are open each day from 8:30 am - 5:30 pm.

9 Week Package
● The 9 week package will cost a total of $1,553. This is equivalent to $172.50 per week of tuition.
● The payments for the 9 week package will be scheduled in advance in three installments. The first payment of $517.66 will draft on May 1st. The second payment of $517.66 will draft on June 1st. The third and final payment of $517.68 will draft on July 1st.

5 Week Package
● The 5 week package will cost a total of $888. This is equivalent to $175 per week of tuition.
● The payments for the 5 week package will be scheduled in advance for three payments. The first payment of $296 will draft on May 1st. The second payment of $296 will draft on June 1st. The third and final payment of $296 will draft on July 1st.
● If choosing the 5 week package, you will need to choose at registration which weeks of summer camp your child will be attending.

● As a reminder, the registration fee will be $95 per child and will be due at the time of registration to secure your child's spot. Registration fees are non-refundable.
● Active members of Augusta Road Baptist Church will receive a 15% discount on tuition.
● There will be no sibling discounts.
● Children will be more than welcome to attend for as few or as many of the 9 or 5 weeks as needed, but all families will be required to pay the full standardized price for their selected level of care.
● If you have any concerns about your ability to pay the above predetermined balances on the set due dates, we will be happy to work with you on establishing the best possible arrangement. Please be sure to communicate concerns of this nature with Leah Meahl.

*Please select the package you would like to register your child for during Summer Camp 2024.
9 week package5 week package

Based on your above choice of package, please select the weeks you intend for your child to attend Summer Camp 2023. This is just an estimated projection; we will only be using the information to inform our staffing and event planning. You will not be penalized based on your answers here. Please note that if you selected the 5 week package, you will be required to confirm your choice of weeks before the start of Summer Camp.

Our Summer Camp begins the week of June 3rd.

Week 1 (June 3-7):Will AttendWon't Attend
Week 2 (June 10-14):Will AttendWon't Attend
Week 3 (June 17-21):Will AttendWon't Attend
Week 4 (July 24-28):Will AttendWon't Attend
*Please note that we will be closed on Thursday, July 4th in observance of the holiday
Week 5 (July 1-5):Will AttendWon't Attend
Week 6 (July 8-12):Will AttendWon't Attend
Week 7 (July 15-19):Will AttendWon't Attend
Week 8 (July 22-26):Will AttendWon't Attend
Week 9 (July 29- August 2):Will AttendWon't Attend

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Liability Releases

*In the event that an accident occurs, I will not hold ARBC responsible for any injury, and am aware that ARBC does not provide accident insurance.
By checking this box, I am indicating that I understand and agree to the above terms regarding my child's care at ARBC.

*I give my consent for my child to be transported by ARBC staff in ARBC vehicles to the Summer Camp and/or any all-day field trips.
By checking this box, I am indicating that I understand and agree to the above terms regarding my child's care at ARBC.

*In the event of an emergency in which I cannot be reached, I authorize emergency medical personnel to provide the necessary first aid and/or hospitalization.
By checking this box, I am indicating that I understand and agree to the above terms regarding my child's care at ARBC.

My child has permission to view movies rated PG and deemed appropriate by the Director.
By checking this box, I am indicating that I understand and agree to the above terms regarding my child's care at ARBC.

I understand that my child may be photographed, videotaped, and/or interviewed for the purpose of ARBC promotional use.
By checking this box, I am indicating that I understand and agree to the above terms regarding my child's care at ARBC.

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Tuition Fees and Payment

The Summer Camp 2024 Pricing Structure is as follows:

*By checking this box, I indicate my understanding that I am responsible for paying my balance in full on the above predetermined dates.

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*Please type your full name below.

NOTE: Once you have paid the $95 registration fee per child, your child will be fully registered for Summer Camp 2022. You will be redirected to the ARBC giving page to make this payment. This will be the ONLY time you use the website to make a Summer Camp payment.
(After clicking 'Submit', you will be redirected to a new page with payment instructions.)