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Child’s Name:___________________________

Best Summer

Ever

2018 Summer Camp Registration Packet

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Child’s Name:___________________________

Summer Camp Registration Checklist

Documents the Boys & Girls Club of Bristol Family Center must have in their possession before your child may start camp.

Required

BBGC&FC Membership Application Yes No

Summer Camp Registration Application Yes No

Weekly Registration Tuition Information Yes

Health Assessment Form Completed Yes

Authorization for the Administration of Medication & IPC - Epi Yes No

Authorization for the Administration of Medication & IPC - Inhaler Yes No

Authorization for the Administration of Medication Individual Yes No

Childcare/Parent Policy Manual Pages Signed (pages # 14 & 15) Yes

Parents Financial Responsibility (page 4) Yes

Signed Field Trip Permission Slip Yes

Signed Swim Permission Slip Yes

Care4Kids PPA Form (if applicable)….C4K Family ID: Yes No

Registration Fee & Non-Refundable Deposit for each week Yes _______________________________________________________________________________________________________________

(Office Use Only) Total Due:

Registration Fee Due: $

Total Deposit Due: weeks X $25/wk = $

Extra T-Shirts: t-shirts X $10/wk = $

Total Payment Due: (add the totals above) $

Total Paid:

Amount Paid: _____________________ Check # $

Date Paid: _________________________ Intake of Registration / Payment -

(Staff Name Please Print) :

Biddy Camp (Rising 1st through 4th grade)

Cadet Camp (Rising 5th through 8th grade)

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Child’s Name:___________________________

2018 Summer Camp Application .

Please complete the registration form below and return it with your registration fee. Checks should be made out to the Boys & Girls Club of Bristol Family Center. Cash payments are not accepted. The paid registration fee and weekly deposit will reserve your child’s spot for the weeks you choose. Your deposit will be applied against the amount owed for the week registered.

Fees Registration Fee paid (non-refundable/non-transferable) on or before April 27th (includes a camp t-shirt) ............................................................................................................................................................................................................ $30.00 Registration Fee paid (non-refundable/non-transferable) after April 30th (includes a camp t-shirt) .... $50.00 Deposit to reserve each week (non-refundable/non-transferable) ............................................................. $25.00/week Traditional Program (9AM – 5 PM) ......................................................................................................................... $185.00/week Extended Day Program (6:30 AM – 6 PM) ............................................................................................................ $205.00/week

(Weekly fees include all activity costs, field trip(s), special events, Morning Snack and a PM snack)

Tuition Payments Please check the appropriate box for the type and weeks of camp you are registering for.

Week # Traditional Extended Day Week of: Tuition Due Date

1 - $185 - $205 6/25/18 to 6/29/18 6/22/2018

2 - $148 - $164 7/2/18 to 7/6/18 (Closed on 7/4) 6/29/2018

3 - $185 - $205 7/9/18 to 7/13/18 7/6/2018

4 - $185 - $205 7/16/18 to 7/20/18 7/13/2018

5 - $185 - $205 7/23/18 to 7/27/18 7/20/2018

6 - $185 - $205 7/30/18 to 8/3/18 7/27/2018

7 - $185 - $205 8/6/18 to 8/10/18 8/3/2018

8 - $185 - $205 8/13/18 to 8/17/18 8/10/2018

9 - $185 - $205 8/20/18 to 8/24/18 8/17/2018

T- Shirt Size: Youth S Youth M Youth L Adult S Adult M Adult L

Extra t-shirts x $10 =

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Child’s Name:___________________________

Parents Financial Responsibility

Tuition Due: Tuition payments are due every Friday for the following week’s care.

Payment is due for the contracted services regardless of absences. If you have applied for C4kids, full tuition is due until your c4kids is approved and a new

tuition agreement is emailed to you with your new rate. Payment will be considered late if not received by 6:00 p.m. on Friday for the next week’s

child care service. A late payment fee of $10.00 may be assessed to your account if payment is not received by

Friday at 6:00 p.m. Services may be suspended if your account is not brought up to date within two weeks. If services are suspended and you receive a termination notice, a $25 fee will be charged to

reinstate care. This fee plus any outstanding balance and a full week’s tuition will be due in full in order to resume care.

Split Payments: The parent that registers the child is the responsible parent, all fees and correspondences

are done through this parent. It is the parents’ responsibility to coordinate on time split payments.

If the tuition percentage of the other parent is not paid, a notice will be sent to the parent on the account (responsible parent).

If full payment is not received from both parties, this could result in suspension of care if the payment falls behind two weeks.

Changes in Tuition: A two week minimum is required for any changes or drops in care, any less than two weeks

can result in full tuition due. More than one change per year can result in a $25 processing fee per change Changes due to C4kids adjustments are not subject to processing fees

Returned Checks/Declined Cards: If a check is returned to us, a fee of $25 will be assessed to your account If your card is declined we will try it a second time but if declined again a new form of

payment will be expected. If your card is on automatic deduction and is declined three weeks in a row, we reserve the

right to take you off automatic deduction charges. Please sign below acknowledging that you have read and understand these terms. Parent/Guardian Signature Date

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Child’s Name:___________________________

Field Trip Permission Slip

All Field Trips and Times Subject to Change Please check off the Field Trips that correspond with the weeks you are registered for Camp.

Read and Sign below if you would like your child to attend.

Wednesday, June 27th ..................................................... Spare Time Bowling, Bristol CT

Thursday, June 28th ........................................................... Swimming @ Woodtick Beach, Wolcott CT

Thursday, July 5th ............................................................. Swimming @ Woodtick Beach, Wolcott CT

Tuesday, July 10th ............................................................. Beardsley Zoo @ Bridgeport, CT

Thursday, July 12th ........................................................ Swimming @ Woodtick Beach, Wolcott CT

Tuesday, July 17th ............................................................... In-house Glazy Days Pottery, Bristol CT

Thursday, July 19th ........................................................... Swimming @ Woodtick Beach, Wolcott CT

Wednesday, July 25th ...................................................... Bristol Blues, Bristol CT

Thursday, July 26th ............................................................ Swimming @ Woodtick Beach, Wolcott CT

Tuesday, July 31st ............................................................. Roller Magic, Waterbury CT

Thursday, August 2nd ........................................................ Swimming @ Woodtick Beach, Wolcott CT

Tuesday, August 7th ......................................................... Flight Trampoline Park, New Britain CT

Thursday, August 9th ........................................................ Swimming @ Woodtick Beach, Wolcott CT

Tuesday, August 14th ..................................................... In-house Carnival Fun (Bounce Zone), Bristol CT

Thursday, August 16th ..................................................... Swimming @ Woodtick Beach, Wolcott CT

Tuesday, August 21st …………………………………….. Lake Compounce, Bristol CT

Thursday, August 23rd ..................................................... Swimming @ Woodtick Beach, Wolcott CT

I give permission for my child, _______________________________________, to attend the selected field trips above, as well as walking to and participating in special events at the Imagine Nation Museum, The Art Studio, Rockwell Park, Immanuel Lutheran (parking lot for activities) and Bristol Public Library.

**If I choose not to send my child on a field trip, or if it is determined my child is not allowed to go on a field trip, I will find alternate childcare for that day. No Staff will remain at the BBGC and no refunds will

be given. Camp T-shirts must be worn on all field trips. No Exceptions **

Parent/Guardian Name (Printed)

Parent/Guardian Signature Date

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Child’s Name:___________________________

Swimming Permission Slip

During camp, all children at camp will have the opportunity to swim. A Red Cross certified lifeguard is always on-duty when campers are in the water. Your child’s safety is our highest priority. Counselors are required and trained to be engaged with the campers when their group is in the pool. We move our staff around in the water to adjust to the OEC State Regulation of a 1:6 ratio when campers are swimming. Children will never be forced to swim if they don’t want to, but they will not be able to leave the swimming area. An alternative activity will be provided for non-swimmers.

Woodtick Beach - Our childcare staff will also be in the water supervising your children from the beach area as well as the floating dock at Woodtick Beach.

Rockwell Park Pool / Splash Pad- On scheduled days, Cadet campers will be walking to Rockwell Park to use their pool, and a swim test is required to ensure their safety at the pool. Biddy campers will be able to utilize Rockwell Parks Splash Pad.

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I give permission for my child ___________________________________________ (Child’s Name) to participate in swimming trips to Woodtick Beach and Rockwell Park.

To insure the safety of your child while swimming, we ask that you check the appropriate designating

box for your child’s swimming ability.

My child is a non-swimmer and may not go in the water. Please provide an alternate activity while at Woodtick Beach or Rockwell Park.

My child is a non-swimmer and may go in the water but must stay in the shallow area. (unable to swim on top of the water)

My child is a novice swimmer and must stay in the shallow area. (capable of swimming on top of the water but unable to tread water for one (1) minute)

My child is a proficient swimmer and may use the floating dock at Woodtick Beach. (capable of treading water for at least one (1) minute).

Parent’s Name (Printed)

Parent’s Signature Date

*BBGC staff will not remain at the Boys & Girls Club when we travel to Woodtick Beach or Rockwell Park for swimming. Staff will be assigned to supervise non-swimmers that do not enter the water.

**In case of inclement weather, our rain date for Woodtick Beach will be Friday.

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Child’s Name:___________________________

Early Drop-Off/Late Pick Up Fee Policy

It is the policy of the Boys & Girls Club of Bristol Family Center’s Camp that all children are dropped off and picked up at the appropriate time.

* Please review the bulleted points below and sign the bottom of this sheet *

Parents/Guardians will be billed the extended care rate of $205.00 per week for children who are dropped off before 8:55am.

If your child is registered for Traditional Camp, and is not picked up by 5:00pm, you will be billed for Extended Day with the exception of days when we arrive back from field trips after 5pm. Additionally, after 6 PM, parents/guardians will be billed one dollar ($1) per minute per child if they are late picking up campers from the Boys & Girls Club of Bristol Family Center.

All early drop-off/late fees must be paid either the night of, or the morning after, early drop-off/late pickup occurs. Children will not be able to attend Camp until early drop-off/late pickup fees are paid in full.

Late fees are determined by the clock above the sign-in sheet area in the West Street lobby for both the elementary school camp and the middle school camp.

Please be sure that all phone numbers and contacts are current.

If a parent is late and no contact has been made after one hour, the Club will contact the Bristol Police Department and DCF.

I have read and agree to the above Early Drop-off/Late Pickup Fee Policy. Additionally, I understand that all late fees must be paid either the night of or the morning after in order for my child to return to Camp. No refunds will be given due to unpaid late pickup fees. _______________________________________ ___________________ Parent/Guardian Signature Date