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Kings Kids Summer Camp 2019 Registration** Please keep this top page for important dates/information. **Location:Kings Education Center (KEC)1797 King AvenueKings Mills, OH 45034513-398-8050 ext. 10040General Dates: May 29- August 9 Information:Ages: Preschool – 6th grade (3 year olds must currently be attending preschool childcare and turned 3 by September 30, 2018, students who have completed 6th grade are not eligible – only those entering 6th grade)Hours: 6:30am - 6:00pmAn exciting summer of activities, field trips and friends!Cost:Registration$50.00 (non-refundable) Beach Waterpark Pass$45.00 (attending on Tuesdays, K & up)Beach Waterpark Lunch Fee $60.00 (1st grade & up)Single Day$55.00* Days must be specified in 2 Days$110.00advance so we may plan for 3 Days$150.00field trips, transportation, 4 Days$160.00activities, and supplies.5 Days$175.00 A 5% discount on total tuition will be applied with more than one child enrolled.One week vacation is available without charge if office is notified 7 days in advance.Applications:Applications will be accepted at each Kings Kids location (JFB, KEC, KME, SLE). Space is limited, therefore we will work on a first come, first served basis. All paperwork and fees must be submitted to secure your child’s placement. When the program is full, applications will be placed on a waiting list. You will be notified when space is available. Questions?Please call (513) 398-8050 ext. 10040 or ext. 10043Kings Kids Summer Childcare Registration 2019Child’s Full Name: _______________________________ Grade in year 2018-2019 __________Name Preference: ___________________ Gender: _________ DOB _______________Address: ___________________________________________ Home phone: ________________ Street CityZipShirt Size: (please circle choice) S M L (child) S M L XL (adult)Mother’s Name: _____________________________ Home phone:________________________Cell/Pager: ___________________ Email Address: ____________________________________Address: _______________________________________________________________ Street CityZipEmployer: ____________________ Occupation: _____________ Work Phone: _______________Father’s Name: ______________________________ Home Phone:_______________________Cell/Pager: ___________________ Email Address: ____________________________________Address: _______________________________________________________________ Street CityZipEmployer: ____________________ Occupation: _____________ Work Phone: _______________MEDICAL INFORMATION: (include city, state and zip)Physician or Clinic Name: ______________________________ Phone: _____________________Address: ________________________________________________________________________Dentist or Clinic Name: ________________________________ Phone: _____________________Address: ________________________________________________________________________ADDITIONAL INFORMATION: (allergies, custody arrangements, emotional/behavioral concerns, non-swimmer, fears, etc.)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ FOR OFFICE USE ONLYDate & Time Submitted: __________________________ (completed by Kings Kids staff)EMERGENCY CONTACTSPeople to be contacted in the event of illness, accident, etc. and permitted to take child home if the parent cannot be reached first. Your child will only be released to the person(s) listed. Please do not list yourself or anyone who does not live close enough to pick up.(State of Ohio Department of Education, requires three to be listed)CONTACT #1Name: _________________________________ Relationship to Child: ______________________Address: ____________________________________City, State, Zip________________________________ Home Phone: ________________________ Cell Phone: ______________________Work Phone: _________________________CONTACT #2Name: _________________________________ Relationship to Child: ______________________Address: ____________________________________City, State, Zip________________________________ Home Phone: ________________________ Cell Phone: ______________________Work Phone: _________________________CONTACT #3Name: _________________________________ Relationship to Child: ______________________Address: ____________________________________City, State, Zip________________________________ Home Phone: ________________________ Cell Phone: ______________________Work Phone: _________________________COMPLETE PART I OR PART II BELOW, DO NOT COMPLETE BOTHPART I – PERMISSION TO TRANSPORT CHILDI give the Kings Kids Summer Childcare my permission to transport ___________________________________ to ______________________________________ (child’s name) (name of hospital or clinic)for emergency care or to ___________________________ for emergency dental care, or to the (name of dentist or clinic)nearest available source of assistance._______________________________________________________Parent SignatureDate*** staff does not transport children to hospitals, clinics, etc. ***PART II – REFUSAL TO GRANT PERMISSIONI DO NOT give my permission to Kings Kids Summer Childcare to transport______________________________ for emergency medical or dental care. In the event of an (child’s name)illness or injury which requires emergency medical or dental treatment, I wish the following action to be taken: _________________________________________________________________________________________________________________________________________________________________________________________________________________________Parent SignatureDate_________________________________________________________________________________PARENT MOVIE CONSENT FORMSome field trips will be to the movie theater. Movies may also be shown while your child is at the KEC. Only “G” or “PG” movies are shown to children (depending on age/grade level). PLEASE CHECK YOUR PREFERENCE: _____Permission to watch both “G” and “PG” movies during summer childcare._____Permission to watch only “G” movies during summer childcare.SUMMER CHILDCARE FIELD TRIP INFORMATIONGroup Going:Summer Childcare ProgramDate:Summer of 2019Dress:Wear camp t-shirt (will receive on first day)Lunch:Sack lunch with drink (box or can)No glass container, please! Pleasemark child’s name clearly on lunch.Please use disposable lunch bags for field trips.Locations:We are currently planning our weekly themes and scheduling trips. Our Summer Program calendar will be available in May.*Beach Waterpark- Ages Kindergarten through 6th grade will go to the Beach every Tuesday. First graders & up will eat lunch at the Beach.*Bowling- Ages 3rd-6th grade bowl at Mason Bowl every Friday. Ages 1st/2nd grade bowl on every other Friday.*Field Trips- other weekly field trips will be listed on the Summer calendar. If a child attends camp on a field trip day, they must go on the field trip. We do not provide care for children to stay at the KEC when the group is out of the building. Children must ride the bus to the field trip. FIELD TRIP PERMISSION FORM___________________________ has my permission to go on any field trips (Child’s Name)provided by the Kings Kids Summer Childcare Program (including swimming). It is understood that he/she is to obey those in charge at all times. Students will not be permitted to attend any field trips unless this form is signed and returned to the Kings Kids Childcare Office.__________________________________________________________(Parent Signature)(Date)SUMMER CHILDCARE FEE AGREEMENTWeekly tuition is expected to be paid in full (no prorated amounts) each Monday preceding your child’s stay. Parents may pay monthly or weekly, in advance. OUR PROGRAM IS SELF-SUPPORTING AND YOUR TUITION IS EXPECTED SO THAT WE MAY KEEP IT AVAILABLE TO YOU. Two weeks delinquent tuition may require that the parent make alternate childcare arrangements. By paying for tuition with your check, you are accepting our check acceptance policy. In the unlikely event your check is returned unpaid, you understand and agree that your check may be electronically re-deposited or if necessary re-deposited by paper draft. You understand and agree that we may collect a return check processing charge of Thirty Dollars ($30.00), by the same means and allowable by law.SUMMER CHILDCAREFEE ______ Registration Fee (per child)$ 50.00** (Non-refundable) ______ Beach Waterpark Pass (not preschoolers)$ 45.00 (If attending on Tuesdays)______ Beach Waterpark Lunch Fee $60.00 (1st grade & up)______ Summer Program (1 circle specified day)$ 55.00**M T W TH F______ Summer Program (2 circle specified days)$ 110.00**M T W TH F______ Summer Program (3 circle specified days)$ 150.00**M T W TH F______ Summer Program (4 circle specified days)$ 160.00**M T W TH F______ Summer Program – Full Week$ 175.00**Monday-FridayA 5% discount on total tuition will be applied with more than one child enrolled.One week vacation is available without charge if office is notified 7 days in advance.VACATION WEEK: Please provide date if known. ________________________________________Please contact us directly if you have any special circumstances regarding attendance.Kings Kids Summer Program’s hours are (6:30 A.M. to 6:00 P.M.) Children may not be signed in before 6:30 A.M. PARENTS WHO USE THE CHILDCARE PROGRAM MUST RESPECT THE PROGRAMS HOURS (6:30 AM – 6:00 PM). LATE FEE PICK-UP FEES ARE $15.00 PER CHILD STARTING AT 6:01 PM AND $5.00 EVERY FIVE MINUTES THEREAFTER. AFTER 4 LATE OCCURENCES, THE CHILD MAY BE DISMISSED FROM THE PROGRAM.Note: If parents are divorced/separated, only one parent may sign the Fee Agreement. The signing parent is totally responsible for payment of registration, late fees and tuition, no exceptions. Custody arrangement copies are required if not already on file with Kings Kids. Kings Kids is not responsible for the replacement or repair of clothing, toys, or any other personal items while attending Kings Kids Summer Program.I/We understand and agree to comply with the terms and conditions of the above agreement. ______________________________________ _______________________________________Child’s Name Parent/Guardian Signature DateKINGS KIDS ON-SITE PREMISSIONI give my permission for ___________________ to participate in all extra non-bus riding field trips not covered under the general field trip permission slip. This would include, but not be limited to, walking around Kings Mills (including the Fire Station, Kings Mills Elementary, Post Office) and nature walks. Children will be required to follow all directions by the staff to insure their safety._____________________________________________Parent SignatureDateKINGS KIDS PERMISSIONI give my permission for __________________________ to participate in activities such as face painting and applying temporary tattoos.______________________________________________Parent SignatureDateKINGS KIDS MEDIA RELEASE PERMISSIONI give my permission for _________________________ to be photographed during various summer activities. These photos may be used in stories written for the Kings EBBN Newsletter and/or stories written for local newspapers. No names would be used._______________________________________________Parent SignatureDate ................
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