Kids Korner Summer Day Camp Application for Admission 2021
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:____________________
2. Name:___________________________________ Relationship to child:_________
Address:__________________________________ Phone:____________________
3. 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. Applications cannot be confirmed unless accompanied by a $25 registration fee per
camper. The fee is non-refundable.
2. Camp size will be limited and reservations will be based on the date of the paid
registration.
3. I give the camp staff authority to act on my behalf in case of emergency.
4. 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.
5. 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.
6. Payment for the camp $100 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.
7. 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.
8. 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 $100 per week for each child in
attendance for a total of 11 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 $1100.
Kids Korner Day Camp, as part of FBC of 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
First Baptist Church 