Camp Voices 2017
ENROLLMENT APPLICATION
(Conyers)
Ages 5 & UP
May 30th – July 28, 2017
6:00 AM - 7:00 PM
**Early Bird Registration Special**
Deadline is May 15, 2017
VOF Members
Non-Members
FREE
$25.00
Camp Registration after May 15, 2017
VOF Members
Non-Members
$25.00
$50.00
Weekly Camp Fee $85.00 per child
Activity Fee $100 per child
1600 Irwin Bridge Rd., Conyers, GA 30012
Phone: 678-374-3500 Fax: 678-374-3505
SUMMER CAMP ENROLLMENT APPLICATION
Today’s Date______________
Child’s T-Shirt Size S M L XL
Adult Sizes
S M L XL
First Time Attending? Y___N___
Member___Member No.________Non-Member___
Camper’s Full Name:
_______________________________ ________________ Age: ______ DOB: ___________________
Last
First
( ) Boy ( ) Girl
Present
Address_______________________________________________________________________________
Street
City
State
Zip Code
Mother: _______________________________________________________________________________
Last Name
First Name
Cell
Father: _______________________________________________________________________________
Last Name
First Name
Cell
Email
Address______________________________________________________________________________
Mother’s Email
Father’s Email
Parent Address (if living separately): ( ) mother ( ) father
______________________________________________________________________________________
Street
City
State
Zip Code
Emergency Contact _____________________________________________________________________
Last Name
First Name
Relationship
Cell
State any mental, emotional or physical handicaps, which may affect his/her activities or progress during
summer camp (all information is confidential):
______________________________________________________________________________________
Has he/she had any psychological testing? (I.e. Attention Deficit Disorder (ADD); Hyper Activity Disorder,
Anger Disorder): ( ) Yes ( ) No If yes what were the results?
______________________________________________________________________________________
Person(s) authorized to pick-up child:
Name______________________________
Name______________________________
Name______________________________
OFFICE USE ONLY:
Date Received: __________
Amount Paid: ___________
Received: T-Shirt________
Relationship______________________________
Relationship______________________________
Relationship______________________________
Accepted By: __________
App Entered: __________
Promo Item __________
PIN Issued: Y__ N__ #______
IES Form Submitted: Y__N__
NOTES__________________
Parental Payment Contract
I (We) reserve enrollment for ______________________________________________________________
in Voices of Faith “Camp Voices.” I agree to pay a non-refundable registration fee.
I further agree to pay weekly fees of $85 per child on Monday of each week by 7:00 p.m. I understand
that a late fee of $15.00 will be assessed after this time. I further, understand that nonpayment of weekly
fees for (1) week will relinquish my child’s place at Camp Voices and that he/she will not be able to return
to camp until all fees and outstanding balances are paid in full.
Parents will not be charged for temporary absences (vacation) or illness to hold a child’s place in Camp
Voices. When campers are going to be absent or will be withdrawn from Camp Voices, we ask that a one
week written notice be given.
Camp Voices will NOT refund any monies for partial weeks of the child’s attendance. Attendance for
one day constitutes a full week and no monies will be refunded.
Payment Breakdown
Registration Fee
VOF Member $25.00 per child after 5/15/2017
Non-Member $50.00 per child after 5/15/2017
The registration fee is non-negotiable and must be paid before camp begins.
Summer Camp T-shirt
$10.00 per child
The t-shirt fee must be paid at the time of registration.
Camp Voices Weekly Fee
$85.00 per child
The weekly fee covers the administrative portion of summer camp. This includes but is not limited to food,
supplies and staff salaries. This fee is non-negotiable and must be paid weekly.
Activity Fee
$100.00 per child
[May be paid weekly/$10 a week]
The field trip/activity fees are not included in the weekly fee. Field Trip & Activity fees must be paid before
any camper is allowed to participate in any camp activities. Campers who do not attend field trips must
find alternate care for the day of the scheduled trip.
Six Flags and White Water Combo Pass
www.sixflags.com
Each camper must purchase a Six Flags and White Water Combo Season Pass. We will alternate between
the two theme parks. Any camper who does not have a pass must find alternate care for the day of the
scheduled trip.
I understand the pick-up time for my child is 6:00 p.m., therefore beginning at 7:01 p.m., I am considered
late and will be assessed a $2.00 per minute charge which is payable at the time of pick-up.
By signing below, I acknowledge that I fully understand my obligation for my child and agree to the terms
in this contract.
___________________________________________________
Parent Signature
_______________
Date
VOICES OF FAITH SUMMER CAMP PARENTAL AGREEMENT
VOF summer camp agrees to provide child care for ____________________________________________
Monday through Friday, from 6:00 a.m. – 7:00 p.m. from May 30th through July 28, 2017.
Medication may be administered during summer camp on a limited basis (Prescription only).
My child will not be allowed to leave the facility without being escorted by the parent/guardian, persons
authorized by the parent/guardian or Summer Camp personnel.
I acknowledge that it is my responsibility to keep my child’s records current and to give notice of
significant changes as they occur (i.e.: telephone numbers, work location, emergency contacts, etc.)
VOF summer camp agrees to keep me informed of any incidents, including illnesses, injuries, death and/or
exposure to communicable diseases, which could possibly include or affect my child.
VOF summer camp agrees to obtain written authorization from me before my child participates in routine
transportation, field trips, or special activities away from the facility.
My child (
) will (
) will not participate in all meal plans. If not, nutritious meals that meet USDA
standards will be provided by: _______________________________________.
I have received, read and agree to abide by the policies of Voices of Faith Summer Camp 2017.
(Parent/Guardian)Signature _____________________________________ Date: ____________________
CAMP VOICES EMERGENCY MEDICAL AUTHORIZATION
_______________________________________
Child’s Name
_____________________
Date of Birth
Should my child suffer an injury or illness while in the care of Camp Voices and the facility is unable to
contact me immediately, it shall be authorized to secure such medical attention and care for the child that
are deemed necessary such as calling 911. I agree to keep the facility informed of changes in telephone
numbers, etc. where I can be reached.
The facility agrees to keep me informed of any incidents requiring professional medical attention involving
my child.
Child’s primary source of Health care is:
___________________________________________
Physician/Clinic Name
_____________________________
Telephone Number
Known medical conditions (i.e. diabetes, asthma, drug allergies): If no known conditions please write the
word “NONE.”
Known food allergies:
Parent/Guardian Signature ___________________________________________ Date ________________
Daytime Telephone ____________________________ Cellular __________________________________
Vehicle Emergency Medical Information
Child's Name _________________________________ Date of Birth _______________
Address ________________________________________________________________
Father's Name ___________________________________________________________
Home Phone ___________________________ Work Phone ______________________
Mother's Name __________________________________________________________
Home Phone ___________________________ Work Phone ______________________
Person to notify in case of an emergency and parents cannot be reached:
Name ________________________________________ Phone ___________________
Child's Doctor _________________________________ Phone ___________________
Address ________________________________________________________________
Child's Allergies __________________________________________________________
Current prescribed medication:
_______________________________________________
Child's special needs and conditions___________________________________________
In the event of an emergency involving my child, and if Voices of Faith Ministries cannot
get in touch with me, I hereby authorize any needed emergency medical care. I further
agree to be fully responsible for all medical expenses incurred for the treatment of my
child.
Child's Name_____________________________________________________________
Signature (Parent/Guardian) ________________________________________________
Witness By ____________________________________Date _____________________
VOICES OF FAITH
SUMMER CAMP
PHOTO RELEASE
Voices of Faith Summer Camp would like your permission to
photograph/video your child for advertisement of our facilities. The
photograph/video will be used for this purpose only. All rights to said
photograph/video will remain the property of Voices of Faith Ministries.
Child’s Name
Parent’s Signature and Date
Director’s Signature and Date
Summer Camp Vacation/Leave of Absence Notification Form
Today’s Date: ____________________________________________________________
Name of Child(ren)________________________________________________________
________________________________________________________
Please select the dates your child(ren) will be on vacation.
Monday
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
6/5 □
6/12 □
6/19 □
6/26 □
Tuesday
5/30 □
6/6 □
6/13 □
6/20 □
6/27 □
7/10 □
7/17 □
7/24 □
7/11 □
7/18 □
7/25 □
Wednesday
5/31 □
6/7 □
6/14 □
6/21 □
6/28 □
7/5 □
7/12 □
7/19 □
7/26 □
Thursday
6/1 □
6/8 □
6/15 □
6/22 □
6/29 □
7/6 □
7/13 □
7/20 □
7/27 □
Friday
6/2 □
6/9 □
6/16 □
6/23 □
6/30 □
7/7 □
7/14 □
7/21 □
7/28 □
Official Use
*A one week written notice must be given to Camp Voices before going on vacation,
leave of absence, or withdrawing your child. I understand that if no written notice is
given to Camp Voices as requested, a $25.00 charge will be added to your account.
Date vacation request was received:_____________________________________
________________________________________________________________________
Signature (Parent/Guardian)