Summer Day Camp Returning Campers

Effective 4/24/24, Kid Central Summer Camp is FULL. If you are signing up now, you will be placed on a waiting list.

Kid Central - Returning Child Registration (your child must have been enrolled in Kid Central within the 23/24 school year to use this form) IF NOT REGISTERED FOR 23/24 SCHOOL YEAR, USE THE NEW CHILD FORM.

Returning Childfull name

Rising Grade

School

Payments are due 2 weeks in advance. Do NOT make any payments until you have a confirmed spot in camp. Vendor copays are due by the 15th of each month.

My Child Will Attend These WeeksChoose Dates

May 28-May 31 (Payment Due May 17) *CLOSED 27thJune 3-7 (Payment Due May 24)June 10-14 (Payment Due May 31)June 17-21 (Payment Due June 7)June 24-28 (Payment Due June 14)July 1-5 (Payment Due June 21) *CLOSED 4thJuly 8-12 (Payment Due June 28)July 15-19 (Payment Due July 5)July 22-26 (Payment Due July 12)

My Child Needs WRAPAROUND CARE for Summer SchoolNew this year: We will provide before and after care for children going to summer school. If you need only M-Th, the weeks summer school is in session, check these boxes. THIS DOES NOT INCLUDE FRIDAYS!

June 5-9 (Payment Due May 26) b/aJune 12-16 (Payment Due June 2) b/aJune 19-23 (Payment Due June 9) b/aJune 26-30 (Payment Due June 16) b/aNo Summer School

Has my permission to attend/travel to the following field trips during Kid Central's Summer Day Camp,
May 28-July 26, 2024. Field Trips are subject to change.

-REC CLUB POOL, CULPEPER (all)
-SPLASH PAD, CULPEPER (all)
-PATH CENTER, CULPEPER (all)
-PARKS & REC FIELDHOUSE, CULPEPER (all)
-BOOM FITNESS (all)
-BOUNCE N' CREATE (Grades K-2)
-LENN PARK (Pre-K Group)
-FUNLAND (Grades 3-8)
-DISCOVERY MUSEUM, HARRISONBURG (Grades K-2)
-DOMINION SKATING CENTER (Grades 3-8)
-SPLASHDOWN WATERPARK, MANASSAS(Grades 3-8)
-CHUCK-E-CHEESE (Grades K-2)
-URBAN AIR, FREDERICKSBURG (Grades 3-8)
-OLD COUNTRY STORE - ICECREAM (all)
-MESSICK'S FARM (all)
-BRIGHTSPOT PLAYGROUND (PreK and Grades K-2)
-BILLY BEEZ MANASSAS (Grades K-2)
-YODER'S PETTING ZOO (PreK)
-DREAM COME TRUE PLAYGROUND (Grades K-2)
-COSMETOLOGY CENTER (Grades 7,8)
-RICHMOND SCIENCE MUSEUM (Grades 3-8)
-RICHMOND CHIDRENS MUSEUM (Grades K-2)
-SKYZONE MANASSAS (Grades 3-8)
-MT. RUN LAKE PLAYGROUND (PreK)
-MOVIES CHARLOTTESVILLE (all)
-BULL RUN PARK (all)
-MASSANUTTEN WATER PARK (all)

Field Trip PermissionAlternate care is not provided

My Child May Go On All Applicable Field Trips

Swimming & Sunblock Permission Form

My child has my permission to go swimming at THE CULPEPER REC CLUB in CULPEPER, VA with KID CENTRAL Summer Camp Staff.

Sunblock Permission

I give Kid Central permission to apply sunscreen to my child(ren) ages 5-8 years of age or to remind my child(ren) ages 9-12 years to apply it to themselves.

Swimming Permissioncheck one

My child MAY get in the poolMy child MAY NOT get in the pool and will sit poolside

My Child is acheck one

Beginner SwimmerIntermediate SwimmerAdvanced Swimmer

Sunscreen Permission

My child has permission to apply sunscreen or have it applied

Please List ANY Changes Since Last Registered for 23/24 School Year. This includes updated phone numbers, addresses, pick up people, medical information, custody papers, etc. If not applicable, write N/A.If no changes, we will use the information from the most recent registration.

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All other information provided on the 23/24 school year registration is accurate. If anything is different, please add it to the box above.

I agree

Parent SignatureFull Name

Parent Phone Number

Best email to reach youa valid email

Date

1. Emergency and Identification Information

Child's Namelast name first

Birth Date

Child's Home Address

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School

Mother's Name

Mother's Home Phone

Mother's Home AddressIf different from child

0 /

Mother's Business Address

0 /

Mother's Work Phone

Mother's Emaila valid email

Father's Name

Father's Cell Phone

Father's Home Phone

Father's Home AddressIf different from child

0 /

Father's Business Address

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Father's Work Phone

Father's Emaila valid email

Desired Start Date

2. Name of persons authorized to take the child from the facility. (The child will not be allowed to leave with ANY other person without written authorization from parent or guardian).

Namefull name

Phone

Relationship to Child

Address

Namefull name

Phone

Relationship to Child

Address

Additional Pick Ups

0 /

PICK UP RESTRICTIONSCANNOT PICKUP

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3. Allergies and/or Medical Limitations

Please explain any allergies or medical limitations (if not applicable put N/A):If your child needs medication administered by us; we MUST have a Medical Authorization form with the correctly labeled meds included. The MAT form must be completed by the parent and the doctor. If your child has a Food Allergy, we must also have an Allergy and Anaphylaxis Action Plan.

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We often take photos and post them to social media, newspapers, etc. Do you agree that your child may be photographed.

I agreeI DO NOT AGREE

This institution participates in the Child and Adult Care Food Program (CACFP) and receives Federal reimbursement to provide nutritious meals for children. Federal CACFPregulations require all parents/guardians to complete and sign a separate Annual Enrollment Form for each child when enrolling their child(ren) with this provider, and every 12 months thereafter. By registering for Kid Central I understand I am enrolling in the CACFP. My Child will be attending M-F between the hours of 6:30 am -6:30 pm receiving Breakfast, AM Snacks, Lunch and or PM Snacks as appropriate. This institution is an equal opportunity employer.

I agree