KIDS KORNER Registration

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

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