JOLLY FUN DAY CAMP (AGES 6-12 YEARS)

REGISTRATION FORM 2016

Child's Name
Child's Name
Child's Birthdate *
Child's Birthdate
M/ F
Child's Address:
Child's Address:
Mother's Information
Mother's Name *
Mother's Name
Home Phone
Home Phone
Cell Phone
Cell Phone
Home Address *
Home Address
Work Address
Work Address
Work Phone Number *
Work Phone Number
Father's Information
Home Phone
Home Phone
Cell Phone:
Cell Phone:
Address
Address
Work Address
Work Address
Work Phone
Work Phone
Marital Status
Identify Legal Guardian
If Other Indicate Name
If Other Indicate Name
Emergency Contacts to call other than parents (minimum of two) in case of necessity, and are authorized to receive child:
Emergency Contact #1 *
Emergency Contact #1
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone:
Cell Phone:
Address
Address
Emergency Contact #2 *
Emergency Contact #2
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Address
Address
Emergency Contact #3
Emergency Contact #3
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Address
Address
Child's Physician
Child's Physician
Phone
Phone
THE DAY CAMP SEASON CONSISTS OF 11 WEEKS from June 13th to August 26th. To enable us to properly staff and plan ACTIVITIES for our camp, please CHECK EACH WEEK BELOW you PLAN to have your child to attend. The first two scheduled weeks in camp MUST be in a row to allow the child to become acclimated and to make friends.
Has your child attend camp before?
Parents, please tell us how you heard of our school:
Indicate SIZE for one free REGULAR T-Shirt for your child: *
I give my permission for the above named child to be taken from the Chicago/Prospect Heights schools to participate in all camp activities. I understand that the camp may take candid pictures or videos of all children using only professional photographers, and unless requested otherwise the pictures or videos may be incorporated into our promotional literature and may be used for advertising purposes. I hereby give my consent and authorize the Jolly Fun Day Camp, as long as my child, my children, or children under my guardianship are enrolled therein, to first contact emergency medical services or to take such child to the hospital or any medical center, for emergency medical care or treatment in the case of sudden illness or accident. I agree to bear the cost, if any, of such necessary emergency care. If your child has any medical restrictions, allergies, or special considerations, please indicate on the registration form. In the absence of restrictions, we will assume your child may participate in all camp activities. With two weeks written notice, registration changes may be made without penalty. However, for each week registered but not attended, full tuition is charged. If you wish your for your child to attend any weeks not indicated on registration form, we will be happy to accommodate you if space is available. Complete the registration form. There is only a two week minimum registration required. We recommend that the first two scheduled weeks in camp are consecutive to allow your child the opportunity to adjust and make friends in camp. REGISTRATION FEE per camper (non-refundable), the FIRST WEEK TUITION and the LAST WEEK SECURITY DEPOSIT are due at the time of registration. Mail the REGISTRATION FORM, POLICY, and payment via check or money order to: Jolly Fun Day Camp. PRE PAY OPTION: Receive a 2.0% discount for tuition if the entire summer is paid in advance (MINIMUM OF 10 WEEKS) We recoomend you pre-order additional T-SHIRTS and TOWELS at the time of registration to insure your child's size.
Digital Signature *
Digital Signature
Date
Date
Date of Admittance
Date of Admittance
Date of Discontinuance
Date of Discontinuance
Receive IDHS
IDHS Approval Date
IDHS Approval Date
IDHS Expiration Date
IDHS Expiration Date
$
$
$
$
$
Date Received
Date Received

Chicago

7559 West Addison Street
Chicago, Illinois

(773) 637-6115

 

Prospect heights

1001 Oak Avenue
Prospect Heights, Illinois

(847) 541-5577