Seeds of Joy - 2022 Summer Camp Registration

Summer Camp Registration Form

A Nurturing, Loving Nursery School Camp for ages 2-5
We're so happy to have your little one(s) join us this summer at Seeds of Joy Summer Camp 2022! Please fill out, remit payment, scan and send in to
seedsofjoy@fpcambler.org or return in person.

ATTENTION - We are WAITLIST ONLY for all weeks of our YOUNG EXPLORERS. Please email seedsofjoy@fpcambler.org to be added to our waitlist. There is STILL ROOM in our INVESTIGATORS.

If you have questions regarding camp, please see our website @ www.fpcambler.org/seeds-of-joy. Camp brochure and pricing are listed on the website. Church office phone is 215-646-3030.

Camp will run for 4 consecutive weeks in June and you may select all 4 weeks,
or select your choice of week(s).
Camp spots will be on a first come, first served basis.
Please register as soon as possible!
STUDENT INFORMATION
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
PARENT 1 INFORMATION
Parent 1 Name

First Name Last Name
Parent 1 Email
example@example.com
Parent 1 Mobile Number
Parent 1 Home Phone
Parent 1 Work Number
Parent 1 Employer
PARENT 2 INFORMATION
Parent 2 Name

First Name Last Name
Parent 2 Email
example@example.com
Parent 2 Mobile Number
Parent 2 Home Phone
Parent 2 Work Number
Parent 2 Employer
PLEASE PROVIDE 2 EMERGENCY CONTACTS
Emergency Contact 1

First Name Last Name
Emergency Contact 1 Phone
Please enter a valid phone number.
Emergency Contact 1 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact 2

First Name Last Name
Emergency Contact 2 Phone
Please enter a valid phone number.
Emergency Contact 2 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please select the weeks your child will attend camp:

Week 1, June 6 - June 10 "How Does Your Garden Grow?" Week 2 June 13 - June 17 "Make a Magical Mess!" Week 3, June 20 - June 24 "Wet and Wacky Water Week" Week 4, June 27 - July 1 "Sensational Stories Week"
Please tell us about your camper - i.e., likes, dislikes, or any information that would be helpful to support your child during our camp time together.
CAMPER MEDICAL INFORMATION
Is the camper up to date on all immunizations? All campers are required to be immunized.

YES NO
Please attach most recent immunization record here:

Cancel of
Please list any allergies to food, medication or environment:
Please list any surgeries, injuries or serious illness:
Please list any medicine taken regularly:
Is any medication required while at camp? If yes, please list below:
In an emergency, does your child require additional assistance (greater than other children of the same age) to evacuate the building?

Yes No
In the event of an emergency evacuation, are there medications or supplies that must be taken with your child?

Yes No
Is your child potty trained?

YES NO
Do you consent to topical product or lotion administered before high sun exposure to exposed area of skin?

YES NO
MEDICAL INSURANCE INFORMATION
Name of Policy Holder

First Name Last Name
Name of Insurance Company
Address of Insurance Company

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Insurance Policy Number
PAYMENT
Link to make a camp payment online

Seeds of Joy Camp Menu:

Young Explorers: (2 to 3 year olds)

(3 days - T, W, TH) $110/week

Investigators: (3s, 4s, and 5 year olds)

(all 5 days) $180/week.

Please remember to follow the payment link after submitting this application - select "Camp Payments June 2022."

Please remember and note your total camp cost for completion of payment.

Please make all checks payable to:

FIRST PRESBYTERIAN CHURCH OF AMBLER.

Thank you!

Please select Young Explorers or Investigators

Young Explorer (2 and 3 Year Olds) - 1 Camp Week Tuesday, Wednesday, Thursday, 9-12

$110	Quantity	Price
Cost per week (check payment)		$ 110.00
With 3% credit card fee		$ 113.30

Item subtotal: $ 0.00

Investigators (4 and 5 Year Olds) - 1 Camp Week Monday-Friday, 9-12

$175	Quantity	Price
Cost per week ( check payment)		$ 175.00
With 3% credit card fee		$ 180.25

Item subtotal: $ 0.00

Total

$ 0.00

Should be Empty:

Summer Camp Registration Form

STUDENT INFORMATION

PARENT 1 INFORMATION

PARENT 2 INFORMATION

PLEASE PROVIDE 2 EMERGENCY CONTACTS

CAMPER MEDICAL INFORMATION

MEDICAL INSURANCE INFORMATION

PAYMENT

Young Explorers: (2 to 3 year olds)

(3 days - T, W, TH) $110/week

Investigators: (3s, 4s, and 5 year olds)

(all 5 days) $180/week.