Summer Camp Application : Christian Life Center Worldwide

The CLCWW Summer camp operates as a Enrichment performance arts program. We offer dance , drama and tutoring. We also, offer breakfast, lunch and a snack. Our operating hours are 6:30am-8am before care , 8am-3pm Camp hours and 3pm-6pm after care. The weekly fee of $105 covers all hours 6:30-6pm. The registration start at $45 per child. It is our mission to enrich the summer experience for each camper by providing a loving , safe and fun atmosphere. Orientation will be May 23 at 7pm.

Summer Camp Application

Child's Name*
First Last
Age*
Date of Birth*
Date Format: MM slash DD slash YYYY
Sex*
- Male
- Female
Address*
Street Address Address Line 2 City State ZIP Code
Phone
T Shirt Size*
Current School of Child*
Grade entering in Fall 2019-2020*
Please check if your child is receiving special services
*Hold CTRL to select multiple* *Special Disclosure: This camp is not under the federal school system guidelines therefore we are not staffed with special needs certified teachers Special needs students requiring certain assistance will require a one on one parental conference. *
List any food allergies
Father's Name
First Last
Employer
Work Phone
Cell Phone
Email
Mother's Name
First Last
Employer
Work Phone
Cell Phone
Email
With whom does the child reside*
- Mother
- Father
- Both Parents
Emergency Care Information
Name of child's doctor*
Phone*
Emergency Contact Information
Name*
First Last
Relationship
Phone
Name
First Last
Relationship
Phone
People to whom the child may be released to (other than parent)
Name
First Last
Relationship
Phone
Name
First Last
Relationship
Phone
In signing this application, we agree to the following*
We (parent/guardian) give our child permission to participate in all Christian Life Center Worldwide’s Performing Arts/Enrichment Summer Program activities. This also assumes voluntary participation in events by the child that includes sports, field trips and all recreational activities. We agree to pay the fee for our child’s care Monday or the first day in attendance for the week. There is a $15.00 late fee for payments not made on time. The weekly fee is $105 per child. We also assume payment for any special activities or field trips. You will be informed prior to the activity. In conclusion, we understand that attendance at CLCWW Performing Arts/Enrichment Summer Program is a privilege and not a right. This privilege may be forfeited by any student who does not conform to the standards and regulations at the school or camp. The camp may dismiss any student at any time. As a parent/guardian, I understand I am 100% responsible for any and all medical expenses incurred on behalf of my child, including, but not to limited to: hospital, emergency room, ambulance, x-ray, co-pay, or prescription fees, etc. I understand that in the event a child needs medical attention, they will be transported to the nearest hospital. CLCWW shall not be held liable for any injuries sustained by my child while in the care of CLCWW. I hereby waive any right I may have to sue CLCWW in the future for any injuries sustained by my child while in the care of CLCWW.
Parent Signature (Input name)
Registration Fee (Non Refundable)
* Registration fees must be included with the application. *
First Child*
Price: $45.00 Quantity:
Second Child
Price: $40.00 Quantity:
Third Child
Price: $35.00 Quantity:
First Week Tuition
Price: $105.00 Quantity:
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Contact Information
Email: summercamp@clcww.org Phone: 770-968-0988 Fax: 770-961-7034 Address: 6337 HWY 42, REX, GA 30273

Summer Camp Application

Summer Camp Application

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Summer Camp Application

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