Camp Wanna-Have-Fun Registration

Camp Wanna-Have-Fun Registration Register at the Community Education Office 455 E. Scripps Road, Room #103 Lake Orion, MI 48360 Phone: 248-693-5436 Fax: 248-814-0203 Summer Office Hours: 8:30 a.m.- 4:30 p.m. Office Use Only Application Form Emergency Card Immunizations Registration Fee Course 9998 Camper s Name Fall 2017 Grade Birthdate Home Phone Work or Cell Phone Address City State MI Zip Email Address T-Shirt Size (please circle): YS YM YL AS AM AL What school does your child attend: If your child does not attend Lake Orion Community Schools, immunization records must be provided BEFORE your child may attend camp. A one-time non-refundable registration fee of $25 is due at registration for each camper. Camp Payment Information Payment Plan - The payment for Weeks 1 thru 4 of camp is due June 16, 2017. Payment for Weeks 5 thru 7 is due July 14, 2017. Payment for Weeks 8 thru 10 is due August 4, 2017. These are the payment due dates for both campers attending all 10 weeks of camp and also those attending only some weeks of camp. Children are not officially registered for a session until the camp balance is paid. If the balances are not paid on time, the child WILL NOT be allowed to begin camp until they are paid IN FULL. REGISTRATION DEADLINE: Your child must be registered and paid by the Wednesday before attending camp the following Monday. A request for reimbursement must be sent to the Community Education Office in writing before the second day of the week your child is enrolled if an unexpected situation should occur. The Director of Camp and the Coordinator of Camp will decide if the tuition is to be refunded. All billing questions must be discussed with Lori McGraw at 693-5436. ADDITIONAL CARE SUPPORT: If the program determines that additional care support is necessary for the enrolled student, the parent/payee will be responsible for the added cost to the program. This cost will be in addition to the regular camp fees. No Daily Rates 5 days per week $135 4 days per week $120 3 days per week $96

Camp Wanna Have Fun Application Form Camper s Name Mother s Name Day Phone Father s Name Day Phone Do both parents reside with child? Yes No Describe visitations rights of parent not residing with child: As a parent, what method of discipline do you use? What is the camper s reaction to this discipline? What do you hope your camper will gain from his/her camp experience? Parent s Agreement 1) I consent to the enrollment of my child in the Lake Orion Community Education Camp Wanna Have Fun Program. 2) I agree to comply with the established policies throughout the course of my child s attendance. 3) I give consent for my child to take part in field trips and participate in Camp Wanna Have Fun activities under proper supervision. 4) I further agree that in case of an accident or injury, emergency medical care may be given in the event that I cannot be contacted immediately. 5) My child is in good health and free from any communicable disease or illness. If my child should become ill, I will notify the camp or main office immediately. 6) I will send my child with a lunch from home on a daily basis. 7) On occasion school district personnel such as social worker, psychologist, and/or speech therapist may be present at the Lake Orion Child Care Learning Center for observation. I give my permission for my child to be observed. 8) Camp hours are 9:00 a.m. to 4:00 p.m., sign-in begins at 8:50 a.m. and pick-up is at 4:00 p.m. Yes No Yes No I give my child permission to attend all field trips throughout the summer and to walk to activities within the CERC building areas. I give my permission to have my child s photograph taken for use on the school web page or for display in the building. If a photo is used on the school website, only a first name is used. Parent/Guardian s Signature Date

GRADE IN FALL 2017 Student Emergency Card Student's Name: Last First Middle Date of Birth: Home Phone: Gender Student's Home Address: House Number Street Name Apt. Number City State Zip Student Mailing Address (if different from home): House Number Street Name Apt. Number City State Zip Primary Parent/Guardian Residing With Student: Relationship: Address (if different from student address): Receive Mailings: Place of Employment: Email: Home Phone: Work Phone: Cell Phone: Secondary Parent/Guardian Residing With Student: Relationship: Address (if different from student address): Receive Mailings: Place of Employment: Email: Home Phone: Work Phone: Cell Phone: Parent/Guardian Living Elsewhere: Relationship: Address: Receive Mailings: Place of Employment: Email: Home Phone: Work Phone: Cell Phone: Parent/Guardian Living Elsewhere: Relationship: Address: Receive Mailings: Place of Employment: Email: Home Phone: Work Phone: Cell Phone: Other Children Who Reside in the Home: Name Birthdate Grade Relationship to Student:

Have custody papers been provided to the district: Yes Date: No Custody/Court Conditions: Please list below LOCAL contact in the order to be called in case of illness/emergency so student can be released: (Note: Unless otherwise specified, parents/legal guardian (from front page), will be contacted first.) 1. Emergency Contact Person: Relationship: Home Phone: Work: Cell: 2. Emergency Contact Person: Relationship: Home Phone: Work: Cell: 3. Emergency Contact Person: Relationship: Home Phone: Work: Cell: 4. Emergency Contact Person: Relationship: Home Phone: Work: Cell: 5. Doctor: Phone: Medical Instructions/allergies/physical restrictions: Other special instructions: In an emergency, the information on this card could be imperative to the welfare of your child; thus we ask that you carefully fill it out and promptly return it to your child's school. Also, PLEASE KEEP THE SCHOOL INFORMED OF ANY CHANGES THAT MAY OCCUR DURING THE COURSE OF THE SCHOOL YEAR REGARDING ADDRESS AND PHONE NUMBER(S).This information is also important in the event that the school must be dismissed early due to weather conditions or mechanical failure in an individual building. Your child should know what to do in these situations. Please inform your child of the procedure he/she is to follow WHEN NO ONE IS AT HOME in the event of early school dismissal. I authorize the physician listed on this document to treat my child in the event of serious illness or accident, when I or the other persons listed on the reverse side of this card cannot be reached. Any obligation for medical expenses resulting from treatment in such a case is my responsibility. Permission to transport my child in case of emergency is also given. Signature: Legal Parent/Guardian Date: Legal Parent/Guardian Date: Were Corrections Made Yes No 12/02/11

2017 Camp Wanna Have Fun Weekly Attendance Child s Name Phone # Parent Name You will be responsible for payment for all weeks requested Credit Card (VISA, MasterCard, Discover) Please check off your choice of days you may choose 3, 4 or 5 days per week If you need before and/or after care, please check the appropriate boxes June 19-23 Week 1 Monday, 19 Tuesday, 20 Wednesday, 21 Thursday, 22 Friday, 23 June 26-30 Week 2 Monday, 26 Tuesday, 27 Wednesday, 28 Thursday, 29 Friday, 30 July 5-7 Week 3 NO CAMP TODAY NO CAMP TODAY Wednesday, 5 Thursday, 6 Friday, 7 July 10-14 Week 4 Monday, 10 Tuesday, 11 Wednesday, 12 Thursday, 13 Friday, 14 July 17-21 Wee2k 5 Monday, 17 Tuesday, 18 Wednesday, 19 Thursday, 20 Friday, 21 July 24-28 Week 6 Monday, 24 Tuesday, 25 Wednesday, 26 Thursday, 27 Friday, 28 July 31-Aug 4 Week 7 Monday, 31 Tuesday, 1 Wednesday, 2 Thursday, 3 Friday, 4 Aug 7-11 Week 8 Monday, 7 Tuesday, 8 Wednesday, 9 Thursday, 10 Friday, 11 Aug 14-18 Week 9 Monday, 14 Tuesday, 15 Wednesday, 16 Thursday, 17 Friday, 18 Aug 21-25 Week 10 Monday, 21 Tuesday, 22 Wednesday, 23 Thursday, 24 Friday, 25 ***************************************************************************************************************************************

Lake Orion Community Education Services Camp Wanna Have Fun Payment Form Child(ren) CAMP RATES: EXTENDED CAMP is available daily 3 DAYS A WEEK -- $96 per camper $6 Before camp (7 am 9 am) 4 DAYS A WEEK -- $120 per camper $6 After camp (4 pm 6 pm) 5 DAYS A WEEK -- $135 per camper A credit/debit card is required for all payments and will be processed automatically on the dates shown. This form authorizes automatic camp payments and charges for schedule changes. PAYMENT DATES: Payment for Weeks 1 through 4 due on June 16 Payment for Weeks 5 through 7 due on July 14 Payment for Weeks 8 through 10 due on August 4 Please charge my $25 registration fee to this card. Please complete and sign: (Visa, MasterCard and Discover accepted) Credit Card #: Exp. Date: CV Code: Signature: Date Printed name: Phone: Once you have completed your registration and calendar for your child s attendance, you will receive a statement showing the breakdown of the amounts your credit card will be charged. OFFICE USE ONLY AMOUNTS TO BE PROCESSED JUNE 16 JULY 14 AUGUST 4

Community Education Services Office 693-5436 Hours M-F: 8:30 a.m. - 4:30 p.m. Room 103 Extended Camp Hours M-F 7-9 a.m. & 4-6 p.m. Room 111 * Camp runs from 9:00 AM to 4:00 PM. Your child will not be at CERC for pick up until 3:50 PM due to campers spending a considerable amount of time out of the building having FUN!! If you need to pick your camper up early, please report to the Community Education Office in CERC (Room 103) or call 248-693-5436 and they ll contact Camp staff. * Sunscreen - please send sunscreen on a daily basis with your camper s name on it, we usually go outside in the morning; they can come to camp with it already applied. * Lunch - be sure to pack a lunch on a daily basis for your campers. It s preferred if children bring food that does not need to be warmed up and then the starving campers don t have to wait for their food If sending your child with warm up food please send food that takes less than 3 minutes to heat. There is only one microwave available and lots of campers!! * - please send your camper with a bathing suit, towel, and goggles with their names labeled on all items on Mondays, Wednesdays, and Fridays for the pool. *Afternoon Snack will be served at 3:50 daily. *Toys from Home please do not send any toys to camp as they may be lost or broken. We provide a wide variety of materials for campers to discover and manipulate. In the event a camper brings a toy or other personal belonging to camp, Camp Wanna Have Fun assumes no responsibility if the item is lost or damaged. * DO NOT allow campers to bring trading cards of any sort to avoid any problems that have occurred in the past. * No Electronic Games will be permitted to avoid problems that have occurred in the past * Headphones/iPods/cell phones will not be allowed. * Questions? Contact: Lori McGraw (248) 693-5436 or email: lori.mcgraw@lok12.org We are looking forward to all the new and returning campers and we can t wait for another FUN AND EXCITING SUMMER AT CAMP!!! Thanks, Camp Wanna Have Fun Staff

June Summer Time at Last! Sports Camp Wanna Have Fun 2017 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 19 20 21 22 23 Argggh! Pirate Day! Friendship Bracelets Meet your summer family! Beachy Attire Scavenger Hunt 26 27 28 29 30 Camper vs. Counselor Day Bowling Field Trip Sports Extravaganza Gymnastics Inflatables Bring your socks! Camp Olympics July Celebrate the Seasons The Great Outdoors That s Show Biz Favorite Sports Team 3 4 5 6 7 No Camp No Camp Have a great 4 th of July!! Feelin the Love Community Service Day Trick-or-Treat Wear a costume Winter Wonder 10 11 12 13 14 Campin at Camp Putt Putt Field Trip Under the Sea Archery Favorite Hat Day 17 18 19 20 21 Spotlight Guests Tie-Dye Day Drummin Around Camp Carnival Grilling With Your Homeys Favorite Food Day Picnic Favorite Color Day

July Science Adventures Arts, Beats, and Eats MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 24 25 26 27 28 Crazy Experiments Microscopes & Making Volcanoes Michigan Science Center Field Trip Wacky Hair Day Detective Day Erupt Volcanoes 31 1 2 3 4 Magician Bike and Scooter Day! You re on TV! CWHF Talent Show Film Fest Wet N Wild Mismatch Day 7 8 9 10 11 Water Balloon Blowout & Games Independence Oaks Field Trip Slip Slidin Away Squirt Gun Wars & Chalk Art Competition Local Hero Visit August Fun and Games 14 15 16 17 18 Superhero Day Minute to Win It World Music Day: African Drumming Field Day 2017 Chillin Day: Antarctica Party Time Camper s Choice Picnic Please bring sack lunch Roller Skating Field Trip Dress Like Your Counselors Movie Day & PJ Day 21 22 23 24 25 Make Your Own Ice Moving Up Day Last Day of Camp Cream Day! Lake Orion Pride Day