Seeds of Joy - 2023 Summer Camp Registration

Seeds of Joy 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 2023! Please fill out, remit payment, scan and send in to
seedsofjoy@fpcambler.org or return in person.

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 5 - June 9 "Scientists in Space" Week 2 June 12 - June 16 "Amazing Artists!" Week 3 June 19 - June 23 "Cooking and Carnivals" Week 4 June 26 - June 30 "Wet and Wacky Water 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:

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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
PHOTO PERMISSION

I give permission that any photo containing my child in Seeds of Joy Nursery School's Summer Camp activities may be used on any of the First Presbyterian Church of Ambler's public social media sites, such as but not limited to the church's Facebook page, Seeds of Joy's Facebook page or in a local news publication or social media site.
Please select one.

YES, I give permission. NO, I do not give permission.
LUNCH MUNCHERS 12PM-1PM

Offered Monday through Friday. Cost for lunch munchers is $10 per lunch date for the entire week selected. If your child chooses to stay for lunch sporadically the cost is $12 per session. We can be informed that morning or the day before if you would like your child to stay. A schedule of lunch muncher dates is provided in our Welcome to Camp Packet, and you can circle the dates that you would like your child to stay ahead of time.
I am interested in adding Lunch Munchers to my child's daily schedule and will add the associated cost onto my total summer camp tuition payment.
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:

Seeds of Joy Summer Camp Registration Form

STUDENT INFORMATION

PARENT 1 INFORMATION

PARENT 2 INFORMATION

PLEASE PROVIDE 2 EMERGENCY CONTACTS

CAMPER MEDICAL INFORMATION

PHOTO PERMISSION

LUNCH MUNCHERS 12PM-1PM

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.