Camp AB Summer Day Camp June 5, 2017 August 4, :00 am 5:00 pm Extended Day 7:00 am 6:00 pm

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Philomena Martin
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1 Abyssinia Baptist Church Interstate Center Drive Jacksonville, Florida Phone: Web: Camp AB Summer Day Camp June 5, 2017 August 4, :00 am 5:00 pm Extended Day 7:00 am 6:00 pm Dear Parent/Guardian, We welcome you to the summer day camp program at Abyssinia! Camp AB is ready to embark on yet another fun and exciting summer. Here your child will participate in art, field trips, swimming, sports, academic enrichment and more. It promises to be a summer of adventure, learning and fun. Thank you for choosing Camp AB! Enclosed you ll find the camp registration form for Summer Day Camp The registration form must be completed and signed when registering your child for camp. A non-refundable fee of $25.00 is paid at registration. The camp is counted by seats. In order for you to secure a seat each week, you must pay a deposit for that seat. The camp is eight (9) weeks long and if you commit to a week, half of that week s deposit is due at registration. The camp fee is $75.00 a week. There is a sibling discount of $25.00 per child (first child $75.00, second child $50.00, third child $50.00, fourth child $50.00), maximum of four (4) siblings. Siblings are sister or brother, cousins or any other related children living in the same household are not considered siblings. You may not substitute a child in your seat. The seat belongs to the child registered. Fees are due each Thursday prior to the next camp week. You will also find the payment schedule enclosed. Campers will not be allowed back to camp if fees are not paid. Payment is accepted in cash, credit cards and certified money order. Please note that no personal checks will be accepted. A field trip list will be provided and whatever trip is selected, payment for that trip is due. Parent Manuals will be available once registration is paid. If you have any questions or concerns, please do not hesitate contact us. We look forward to a great summer! Sincerely, Dr. Eugene W. Diamond Senior Pastor AB Summer Camp App 2017_Revised 05/10/ Regular

2 Camp AB Summer Day Camp Application Weekly camp fee - $75 Registration fee - $25 non-refundable (Includes camper shirt) - PER CHILD Activity Fee (Covers transportation to pools and field trips non-refundable) - $50 DUE BEFORE THE FIRST FIELD TRIP Extended Day Morning or Afternoon Only $10, Morning & Afternoon - $20 Junior Counselors (Ages *Job Application filled out -only 5 slots available) $25 per week Child s Name: Birth Date: Age: Grade: Parent/Guardian Name(s): Mother: Father: Guardian: Address: (Primary address that child lives at) City: State: Zip: Home # Work # Cell # Shirt Size: Youth YS YM YL Adult AS AM AL AXL AXXL AB Summer Camp App 2017_Revised 05/10/ Regular

3 Emergency Contacts: Name: Relationship Persons authorized to pick up child in addition to parents/guardian (must show ID on first visit) 1. (ID checked ) 2 (ID checked ) 3 (ID checked ) Persons not authorized to pick up child Medical: Please list any medical conditions that we need to be aware of. (i.e. asthma, seizures, bee stings) Family Physician: Phone: AB Summer Camp App 2017_Revised 05/10/ Regular

4 Camper Breakdown We DO NOT pro-rate for days not attending. These rates apply for ALL campers new or returning. If you commit to attending any week or the entire camp, half of the weekly fee is due upon registration. Weekly Breakdown (Please choose week. $30 deposit is due per week selected) Week 1 June 5 9 Week 6 July Week 2 June Week 7 July Week 3 June 19 June 23 Week 8 July Week 4 - June 26 June 30 Week 9 July 31 August 4 Week 5 July 3 7 No. of weeks selected Weekly fees are due THURSDAY 5:00 PM PRIOR TO THE NEXT WEEK Please choose before/after care Before Care $10 After Care $10 Before and After $20 Payment Schedule Month Dates Fee Extended Day Due Date Week 1 June 5-9 $ $ June 1 Week 2 June $ $ June 8 Week 3 June 19 - June 23 $ $ June 15 Week 4 June 26 - June 30 $ $ June 22 Week 5 July 3-7 $ $ June 29 Week 6 July $ $ July 6 Week 7 July $ $ July 13 Week 8 July $ $ July 20 Week 9 July 31 August 4 $ $ July 27 AB Summer Camp App 2017_Revised 05/10/ Regular

5 Please answer the following: Yes No My child has permission to go on field trips using bus transportation. My child has permission to swim at city pool or on field trips. I give permission for the camp staff or emergency care personnel to Administer first aid or medical treatment in the event of an emergency Involving my child. I give permission for my child s photo to be taken during activities For documentation and/or publicity purposes. I hereby give my child permission to participate in the Abyssinia Baptist Church Summer Camp Program. I understand that the Abyssinia Baptist Church is not responsible for any accidents or injuries unless there is negligence on their part. Parent/Guardian Signature: Date: PARENT S AGREEMENT: Please sign below There is a $25 non-refundable registration fee, which does not go towards your camp balance. Please review the brochure for the cost of each week for day camp and extended hours. In the event of cancellation, your deposit will not be refunded. If child misses a day or more during the week, there is no deduction of fees. I also acknowledge payment is due Thursday before the next week. Payment accepted in cash, credit cards, or certified money order. (NO CHECKS) Parent s Signature Date Credit Card Payment: Please mark one Type of Card Master Card Visa American Express Zip Code Card No. Name (as it appears on card) Exp. Date FOR OFFICE USE ONLY Weeks selected Deposit Amt Paid: Weekly Amt Activity Fee Reg Fee Date of Deposit Paid AB Summer Camp App 2017_Revised 05/10/ Regular

CHILD S NAME AGE. BIRTH DATE GRADE COMPLETED AS OF 6/2016 MEMBER (check one) Yes No MOTHER MOTHER S ADDRESS STREET CITY STATE ZIP

CHILD S NAME AGE. BIRTH DATE GRADE COMPLETED AS OF 6/2016 MEMBER (check one) Yes No MOTHER MOTHER S ADDRESS STREET CITY STATE ZIP TALLAHASSEE MUSEUM JUNIOR COUNSELOR IN TRAINING REGISTRATION FORM Please use a separate form for each child. Contact 575-8684 ext 126 for more information. This camp training program is limited to 2 candidates