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2008 SUMMER CAMP ENROLLMENT APPLICATION

June 2 – July 25, 2008  (Closed July 4^th)

 STUDENT INFORMATION

Last Name                                                                              First Name                                                   Middle Name                                                             _________________________________________________________________________________________________________________________

   Birth Date                                              Age (2-9 Years Only)                               Current Grade in 2008/2009 (2 Year Olds-4^th Grade Only)     

 

Status:          □ New  Camper           □ Returning Camper

Gender:          □  Male              □  Female

 

PARENT/GUARDIAN INFORMATION

 Father/Guardian                                                                                                   Mother/Guardain

□Mr. □Dr. ________________________________________________          □Mrs. □Ms. □Dr._______________________________________

 Relationship _______________________________________________            Relationship ____________________________________________

 Preferred Name ____________________________________________           Preferred Name __________________________________________

 Social Security Number _____________________________________           Social Security Number _________________________________

 Street Address _____________________________________________            Street Address __________________________________________

 City, State, Zip _____________________________________________          City, State, Zip __________________________________________

 E-Mail Address _____________________________________________         E-Mail Address __________________________________________

 Employer __________________________________________________         Employer _______________________________________________

 Occupation/Title ____________________________________________         Occupation/Title _________________________________________

 Employer’s Address _________________________________________         Employer’s Address ______________________________________

 City, State, Zip _____________________________________________         City, State, Zip ___________________________________________

 Home Phone _______________________________________________          Home Phone ____________________________________________

 Cell Phone _________________________________________________         Cell Phone ______________________________________________

 Business Phone _____________________________________________          Business Phone _________________________________________

 Currently enrolled students and their siblings receive priority for enrollment.  Spaces will be reserved on a first-come, first-served basis when a full deposit and application are returned.   Once the Admissions Office has received your signed enrollment agreement and your deposit, you will receive notification when your child has been accepted.  Applications will not be accepted without a $100.00, non-refundable deposit that will be applied to your June payment.

 EMERGENCY CONTACT & MEDICAL INFORMATION

Person, other than parent, authorized to act for parent in an emergency:
Name		Relationship		Address
Home Phone	Cell Phone		Employer		Business Phone

 Name of Dentist ___________________________________________            Phone Number ___________________________________________

Does Your Child Need to Take Medication at Summer Camp?       □ Yes       □ No

Is Your Child Allergic to Anything of Which You Are Aware?        □ Yes        □ No           

If “Yes”, Please List Allergies:  __________________________________________________________________________________________________

 IMPORTANT NOTE:  All parents must comply with regulations concerning records, such as immunizations, data forms, policies, medical authorization, etc., before students may enter camp.

 TRANSPORTATION RELEASE

To ensure the safety of your child, please list other adults to whom your child may be released or who are authorized to provide transportation for your child.

 Name _________________________    Relationship _______________    Phone _________________________

 Name _________________________    Relationship _______________    Phone __________________________

 Name _________________________    Relationship ______________    Phone ___________________________

 

GENERAL INFORMATION

Has Your Child Experienced Any of the Following During the Past Year?      □ Moving        □ Birth of a Sibling       

□ Serious Illness in Family          □ Death in Family        □ Separation or Divorce of Parents      □ Other, Please Explain ____________

________________________________________________________________________________________________________________________

 

Does Your Child Have Any Strong Fears?      □ Yes      □ No          If Yes, Please Explain ____________________________________________

________________________________________________________________________________________________________________________

 

Does he/she usually get their own way with other children?    □ Yes       □ No

If not, what is the reaction? _____________________________________________________________________________________________________

 Sibling Name _____________________________________  Age ___________  Applying to ASES Summer Camp    □ Yes         □ No

Sibling Name _____________________________________  Age ___________  Applying to ASES Summer Camp    □ Yes         □ No

Sibling Name _____________________________________  Age ___________  Applying to ASES Summer Camp    □ Yes         □ No

 Publicity

Unless a letter to the contrary is received by the Head of School, enrollment in All Saints' Episcopal School gives the school administration permission to use your son’s/daughter’s picture on the official school web site and in newspaper advertisements or other publications.