KIDS KORNER Registration

Kids Korner Summer Day Camp Application for Admission

First Baptist Church of Lexington

525 S. Bus Hwy 13

Lexington, MO  64067

 

Camper’s Name (first and last): ________________________________________________

 

Gender: ____________          Birthday: ________________      Current Age:_____________

 

Last Grade Completed:_________________  Attending Summer School:________________

 

Parents’ Names:_____________________________________________________________

 

Email Address:______________________________________________________________

 

Camper lives with:  Father_____ Mother_______   Both _______ Other_______________

 

Home Church:_______________________________________________________________

 

Family Information

 

Home Address:______________________________________________________________

 

City:_________________________ Zip:__________Home phone:______________________

 

Father’s cell phone:___________________________  Work phone:_____________________

Mother’s cell phone:___________________________ Work phone:_____________________

 

Emergency contact:___________________________ Phone:__________________________

 

This child may be released to the following person(s):

 

  1.  Name:___________________________________ Relationship to child:____________

Address:__________________________________ Phone:_______________________

 

  1. Name:___________________________________ Relationship to child:____________

Address:__________________________________ Phone:_______________________

 

  1. Name:___________________________________ Relationship to child:____________

Address:__________________________________ Phone:_______________________

 

Camper Information

Does your child have an epi  pen? Yes No Does your child need an inhaler?  Yes No

 

Allergies:______________________________________________________________________

 

______________________________________________________________________________

 

Medical restrictions:_____________________________________________________________

 

_____________________________________________________________________________

 

Are there any medical problems, dietary or activity restrictions that the camp staff should be aware of?_____________________________________________________________________

 

_____________________________________________________________________________

 

General behavior (comment on personality and emotional development; does the camp have difficulties, fears, or anxieties?)___________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

Conditions of Enrollment

  1. There will be no camp on Memorial Day, Monday, May 25th nor on Independence Day observation July 3.
  2. Applications cannot be confirmed unless accompanied by a $25 registration fee per camper.  The fee is non-refundable.
  3. Camp size will be limited and reservations will be based on the date of the paid registration.
  4. I give the camp staff authority to act on my behalf in case of emergency.
  5. Kids Korner Day Camp reserves the right to terminate registration of any camper if, in the opinion of the committee, it is in the best interest of the child or the day camp.
  6. The parent and guardian hereby consents to the use by Kids Korner Day Camp of the camper’s photograph or video image for public purposes.  We will have a Facebook page again this year.
  7. Payment for the camp $90 per week must be received no later than drop-off time on the first day of each week of camp in order for the camper to participate that week.  Non-payment will mean dismissal from the day camp.
  8. A cancellation notice must be given to the camp director at least two weeks in advance; otherwise the full payment for the weeks registered will be charged.
  9. As parents, we understand the risks involved with camp activities and that no environment is risk free.  We accept responsibility and grant permission for our child to participate in all camp activities and off campus excursions.

 

I/We have read, understand, and agree with the Conditions of Enrollment detailed above.  Please enroll my child as named herein at Kids Korner Day Camp.

 

_______________________________________     _____________________________

Parent Signature                                                         Date

 

Please return your completed application with your $25 non-refundable registration fee per camper to:

Kids Korner Day Camp

First Baptist Church

525 S. Bus 13 Hwy.

Lexington,MO  64067

 

I understand that during all activities, pictures will be made in which our child may be photographed or videotaped.  I give permission for photos/videos of my child to be displayed in any published matter and/or the church website or Kids Korner Day Camp Facebook page. _________( Initials Parent/Guardian)

 

I have read and understand the General Policies for Kids Korner Day Camp. ______ (Initials Parent/Guardian)

 

T-Shirt Size of Child:___________________________

 

General Policies for Kids Korner Summer Day Camp

 

Pickup and Dropoff:

Parents are responsible for bringing their child/ren into the Education Building of FBC Lexington and sign them in and out each day, using the side entrance.  On the enrollment form, list all persons authorized to pick up your child in both normal and unusual circumstances. All persons not known to the staff will be asked to show identification.

 

What to Bring:

Children must wear tennis shoes.  We will be playing outside every day, weather permitting.  Each child should bring an extra set of clothes and a bottle of sunscreen in a backpack in case needed.  On Wednesdays and Fridays, children will need a towel, flip flops and bathing suit for pool time. Children should have sunscreen applied each day at home before coming to camp. Children will be given time to reapply sunscreen before going outdoors in the afternoon.  Be sure to send sunscreen that the child can apply by themselves. Do not bring toys or electronics from home, unless requested to do so.

 

Payment:

Parents/Guardians are responsible for prompt payment of $90 per week for each child in attendance for a total of 12 weeks.  Payment is due no later than drop off time of the week in attendance. Payment may be made through electronic means. More information will be given about this method at a later date.

The total cost for the summer is $1080.

 

Kids Korner Day Camp, as part of FBCof Lexington, is a mandatory reporting facility; therefore, any suspected child abuse or neglect will be reported within the guideliness of the Mandated Reporter Law. Our primary focus is the protection of your children.

 

 

 

Registration Forms:

2020 Kids Korner Registration – Lexington Families:

Kids Korner Summer Day Camp Application for Admission 2020

 

 

To complete registration, print the downloadable forms and return via the following methods:

  1. Bring completed form to the FBC church office: Mon-Thurs 9:00am to 3:00pm
  2. Scan/Email the completed form to:  fbcoflex4@embarqmail.com
  3.  Mail to: First Baptist Church 525 S Business HWY 13 Lexington, MO 64067

You may also call the church office during business hours at 660-259-3915 with any questions.

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