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SUMMER CAMP

2019 REGISTRATION

Thank you for choosing Adventure Club this summer. We are honored to be a part of your family.

Please return this packet, in its entirety, with the registration fee to the

Adventure Club office by April 26, 2019.

All Pages need to be fully filled out, signed and returned. Adventure Club is unable to provide

services and/or save your child spot until registration has been paid and all paperwork has

been fully completed and submitted. Incomplete packets will not be accepted.

If you have any questions about completing this packet, please call 727-799-1618 x1012 and

ask for Nicole Reitmeyer or Sarah Moran.

You can also email us at :

[email protected] or [email protected]

mailto:[email protected]

What is Adventure Club?

Adventure Club is a ministry of Countryside Christian Church. We are a Before and After

School program and Summer Camp. We serve Pinellas Country and the greater Tampa Bay area

with Child Centered Learning guided by Christian principles. Experienced counselors and staff create

an atmosphere that is fun, safe and with a supportive setting that provides a stimulating environment

where each child has the opportunity to work, play and do activities that inspires them to do great

things.

What makes Adventure Club’s Summer Camp so special?

There is something here for EVERYONE! We strive to engage all children in the development

of their God given potential.

We have smaller groups, with each group spilt by age, so each activity is tailored to the age for

an assortment of fun.

We accept student that have completed Kindergarten and are going into 1st grade through 8th

grade.

Adventure Club is the perfect fit for your child this summer. There is enough fun, variety,

exciting trips and amazing activities to last all summer.

We provide families a safe and caring environment in a Christian atmosphere. Each week

there is interactive chapel with praise and worship and daily devotions.

You can choose which weeks you plan for your child to attend, that way you know which camp

trips/activities will be right for your child and what weeks fit into your summer schedule.

Students are transported to and from field trips in 15 passenger vans, or rented transportation.

All vehicles have passed current safety regulations and have seat belts for all passengers.

Adventure Club is the perfect fit for students who wants to attend all summer or just a few

weeks.

Once you receive the registration packet, fill it out and return to adventure club office.

Registration Fee is per child and due at time of registration.

For questions please call 727-799-1618 x 1012 or

Email: [email protected] or [email protected]

mailto:[email protected]

ADVENTURE CLUB SUMMER 2019

Child Summer Camp Information Form

Child’s Name: ____________________________________ Grade (for 2019/20 school year): _________ Gender: _________

Parent/ guardian Name: ______________________________________ Cell Number:_______________________________

Home Address: ________________________________________ City: ______________________ Zip: _________________

Main E-Mail Address: ____________________________________ Work Phone: ___________________________

Registration Fee: $50.00 for Summer Camp

Payment Methods: Auto-Withdrawal is the method of payment. Please turn in your tuition express sheet fully filled out.

*Auto-withdrawal payments will be taken out weekly, every Monday. Weekly fees:

Returning A.C. Campers: Kindergarten (Child must be going into 1st grade for the 2019-2020 school year) - 8th Grade: $160.00

New A.C. Campers: Kindergarten (Child must be going into 1st grade for the 2019-2020 school year) - 8th Grade: $180.00

$10 late fee will be applied for any missed payments.

Weekly fee includes all field trips, transportation, activities, special guests, and a daily snack.

Limited space

Select Weeks: PLEASE CHECK EACH WEEK YOUR CHILD WILL ATTEND. Your spot is only guaranteed for the weeks that are checked

**DUE TO LIMITED SPACE YOU WILL BE CHARGED FOR THE WEEKS CHECKED BELOW, WHETHER THEY ATTEND OR NOT.

Each week we will be going to local parks, movies, main field trip and pool. (Main field trips are listed below). Field trips may be changed due to weather, scheduling conflicts with the trip provider, illness, transportation problems, or other factors beyond our control. NO REFUND WILL BE GIVEN DUE TO FIELD TRIP CHANGES. The canceled trip may be replaced with another trip or special event on another day. ______ Week 1 (June 3 - 7) Stay on campus / local parks

______ Week 2 (June 10 - 14) Threshers baseball game

______ Week 3 (June 17 - 21) Zoo Tampa

______ Week 4 (June 24 - 28) Clearwater Marina Aquarium

______ Week 5 (July 1- 5) Stay on campus / Walk to CiCi’s (Adventure Club will be Closed July 4th)

______ Week 6 (July 8 - 12) AirHeads Jump Arena

______ Week 7 (July 15 - 19) X-Treme Fun Center

______ Week 8 (July 22 - 26) Bowling

______ Week 9 (July 29 - 2) Weeki Wachee

______ Week 10 (Aug 5 - 9) Future Flipz / End of Summer Party

One t-shirt Included with registration T-shirt size (Circle One): Youth Sm / Youth Med / Youth Lrg / Ad Sm / Ad Med / Ad Lrg / Ad XL

Additional T-shirt/s @ $8.50 each: # of additional shirts_____________ Shirts will be ordered by April 26th, 2019. Shirts are only

guaranteed if ordered by this date.

My signature notes agreement with above information stating that you are obligated to pay for any and all checked weeks whether

your child actually attends or not. Also, I understand that my child’s spot is only guaranteed for the weeks that I have checked.

Payments are due each Monday of the week your child attends and will be processed Monday morning.

Signature: _________________________________________________ Date: __________________

***Office Use Only: Date Received: ___________________ Received by: ____________________

Packet includes these forms listed below.

The packet can only be filled out for one individual child, each additional child must have their own packet filled out and turned in.

Each form must be filled out entirely (Everything must be filled out /no blank lines). Please return completed packet with registration fee to the Adventure Club office.

Spots are not guaranteed unless packet is filled out entirely, weeks are checked and registration fee is paid.

Packet is due by April 26, 2019.

ₒ Registration / Child Camp Information Form

ₒ Child’s Enrollment Record

ₒ Child Information and Emergency Medical Release (notary must sign)

ₒ Permission Form (notary must sign)

ₒ Adventure Club Rules and Regulations / Code of Conduct

ₒ Student Code of Conduct

ₒ Flu Brochure

ₒ Tuition Express

ₒ *Keep - Parents Copy - Know your childcare center brochure

ₒ *Keep - Parents Copy – Adventure Clubs Rules and Regulations/Code of conduct

Directors Use Only: Date enrolled:__________

CHILD’S ENROLLMENT RECORD

Child’s Full Legal Name:_____________________________________________________________________________ Sex:_______ First Middle Last Nickname

Birth Date:_________________ Main Telephone (_______)___________________ Main Email:______________________________

Child’s Physical Address:________________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

School Child Attends:__________________________________________ Grade for 2019-2020 school year:____________________

Primary hour’s child will attend: from_______to_________ Days of the week child will attend:_______________________________

Who has legal custody: Both Parents Mother Father Other: Name____________________________________

Child lives with:_______________________________________________ Relationship to child:________________________________

Father’s Name:___________________________________________________ Email:_______________________________________

Home Address:__________________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

Home Phone:_____________________________ Cell phone:___________________________ Provider:_________________

Occupation:___________________________________________________________ Title:_____________________________

Place of Employment:_____________________________________________________________________________________

Address of Employer:______________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

Work Telephone:_______________________________ Work Email:______________________________________________

Mother’s Name:__________________________________________________ Email:_______________________________________

Home Address:__________________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

Home Phone:_____________________________ Cell phone:___________________________ Provider:_________________

Occupation:___________________________________________________________ Title:_____________________________

Place of Employment:_____________________________________________________________________________________

Address of Employer:______________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

Work Telephone:_______________________________ Work Email:______________________________________________ Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be

contacted and are authorized to remove the children from the children’s center in case of illness, accident, or emergency, if for some

reason the custodial parent(s) or legal guardian(s) cannot be reached. (Must have 2 contacts (other than the parents/guardians)

All persons listed below must have full address with phone numbers, Does NOT need to be local).

1. Name:________________________________________________ Email:________________________________________________

Home Phone:____________________________________________ Cell Phone:____________________________________________

Home Address:_________________________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

2. Name:________________________________________________ Email:________________________________________________



3. Name:________________________________________________ Email:________________________________________________



4. Name:________________________________________________ Email:________________________________________________



CONTINUED ON BACK

Medical Information: Child’s Physician/Health Resource:__________________________________________________________________________________

Telephone Number:______________________________________________________________________________________________

Address:_______________________________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

Hospital Preference:___________________________________________________________________________________________ Name of Dentist:________________________________________________ Telephone:____________________________________

Address:_____________________________________________________________________________________________________ (Street Address (number, street, apartment #) City State Zip Code

Emergency Care Plan instructions: for life threatening illness/lifesaving medications (ONLY FILL OUT if applicable):

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________ MISCELLANEOUS INFORMATION List of all know allergies:__________________________________________________________________________________________

List all identifying scars, birthmarks, skin discoloration:_________________________________________________________________

Special Medical or dietary needs of child:_____________________________________________________________________________ List any areas of concern:__________________________________________________________________________________________

My signature and initials below verifies that: Initial All: Childcare info ______ I give permission to consult the child’s physician/health resource listed above in case of emergency if parent cannot be reached.

______ I have received a copy of “The Flu, A guide to parents” brochure.

______ I have received a copy of the “Know Your Child’s Children Center” brochure, & a copy of the children’s center discipline policy.

______ I was notified that the snacks/meals served daily are: PM snacks

Initial All: Photo usage ______ I understand that Countryside Christian Church and any of its ministries or aliases, (Preschool/ Before and Aftercare / Adventure Club, Etc) to

use photos of my child/children for school activities including but not limited to social media websites such as Facebook or Instagram and Countryside

Christian Church and/or Adventure Club websites.

Initial only one: I give permission for my child to participate in food related activities (birthday, special occasions, class parties, etc) ______ My child does not have a food allergy or dietary restrictions.

______ My child does have a food allergy or dietary restriction. My child may participate, but may not eat or handle the following

items:__________________________________________________________________________________________________

___________________________________________________________________________________________________

______ My child does have a food allergy or dietary restriction and may NOT participate in food experience.

Initial All: Tuition & policies ______ I understand that Tuition is due REGARDLESS of whether or not the student is in attendance. There are NO REFUNDS, DISCOUNTS or

COMPENSATION for absence, illness, vacation, holidays, and/or school closures. I also understand that my child’s spot is only guaranteed for

the weeks that I have checked. I understand that I am obligated to pay for any and all checked weeks whether your child actually

attends or not and any weeks that may be added at a later date. ______ Automatic withdrawal is the method of payment. Tuition express form will need to be filled out. Each weekly payment

will be processed every Monday that your child is registered for.

_______ I have receive & read the Adventure Club rules & regulations, along with the discipline and expulsion policies of Adventure Club.

_______ I understand field trips may be changed due to weather, scheduling conflicts with the trip provider, illness, transportation problems, or other

factors beyond our control. NO REFUND WILL BE GIVEN DUE TO FIELD TRIP CHANGES.

Sign All: I grant permission for Countryside Christian Preschool in the case of an emergency to evacuate my child. I understand they will walk if

possible to Paul B. Stevens School. If necessary they may be transported by vehicles.

Signature of Custodial Parent or Legal Guardian: _____________________________________________ Date:____________

I verify that the information on this enrollment form (front and back) is complete and accurate. I hereby grant

permission for the staff of this facility to have access to my child’s records.

Signature Custodial Parent/ Legal Guardian: _________________________________________ Date:______________

CHILD INFORMATION AND EMERGENCY MEDICAL RELEASE

Form must be in Print, FILLED OUT ENTIRELY and be the originally signed / notarized form (and contain only one child’s name).

Child’s Full Name: _______________________________ DOB.: _____ / _____ / _____ Last Tetanus: ______ / ______ Month Year

Allergies or Medical Conditions: __________________________________________________________________________ Medications Routinely Taken: ____________________________________________________________________________________ School: _____________________________________________ Grade (for 2019-2020 school year): __________________ Name of Legal Parent(s)/Guardians: ____________________________________ Relationship: _____________________ Home Address: ____________________________________ City: ________________________ Zip: _______________ Home Telephone: (____)________________ Work: (_____)_________________ Cell: (_____)_________________ Mom’s Name (First and Last): ____________________________________________Email:__________________________ Home Telephone: (____)________________ Work: (_____)_________________ Cell: (_____)_________________ Dad’s Name (First and Last): _____________________________________________Email:_________________________ Home Telephone: (____)________________ Work: (_____)_________________ Cell: (_____)_________________ Child’s Physician: ______________________________________________ Telephone (_____)_______________________ Address: _________________________________________________________________________________________

Street Address (number, apt., street) City State Zip Code Hospital Preference:_____________________________________________ City:________________________________ Medical Insurance Co: _________________________Policy Number: _________________ Expiration Date:____________

Emergency Contacts - Only used if the custodial parent(s) / guardian(s) cannot be reached: Full address & phone number 1. Name _________________________ Address _________________________________________________________

Street Address City State Zip Home Phone: (_____)__________________ Work or Cell: (_____)__________________ Relationship:__________

Circle One: 2. Name _________________________ Address _________________________________________________________

Street Address City State Zip

Home Phone: (_____)__________________ Work or Cell: (_____)__________________ Relationship:__________

Circle One: Additional Persons Eligible to Pickup

Full Name: ____________________________ Home Phone: (_____)__________________ Work or Cell: (_____)___________________




___________________________________________________________________________________________________

PLEASE SIGN IN THE PRESENCE OF A NOTARY: I hereby give my consent to consult the child’s physician / health resource listed above in case of emergency if parent / Guardian cannot be reached. I also hereby give my consent to any emergency facility and physician to administer necessary treatment to my child, _________________________________, in the event of an emergency at which time I cannot be reached. I also give consent to transport by ambulance if the situation warrants it. Signature: __________________________________________________________ Date: _____________________

Custodial Parent / Legal Guardian (Affiant) STATE OF FLORIDA: COUNTY OF PINELLAS The foregoing instrument was acknowledged before me this ________ day of ________________, 2018

by _________________________________, who is ___ personally known to me or ___ has produced the following identification –

State Issued ID #: ___________________________ Other ID #: ______________________________. Notary Stamp or Seal:

________________________________________ Signature of Notary Public

SUNSCREEN , BUG REPELLENT & OTHER OVER THE COUNTER CREAMS/LOTIONS PERMISSION FORM CHILDS FULL NAME:______________________________________________________ SUNSCREEN As a parent/guardian of the above child I understand my child will be playing outside, every day; weather permitting. Therefore, I give permission for the staff at Countryside Christian Adventure Club / Before & After Care to apply sunscreen that I the parent have provided. I understand the sunscreen needs to be in a spray only with broad spectrum with SPF-30 or higher and may be applied to my child. I understand that staff can only apply spray or aerosol spray types of sunscreen and the sunscreen may be applied to exposed skin, including but not limited to the face (except eye lids), tops of ears, nose, bare shoulders, arms and legs. Please initial one: _______ I allow Countryside Christian Adventure Club / Before & After Care staff to apply my child’s Sunscreen as needed. Must fill out info below.

When is it needed and how often: ___________________________________________________________________________________________________

___________________________________________________________________________________________________ Directions to apply spray Sunscreen: ___________________________________________________________________________________________________

___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _______ I choose NOT to allow Countryside Christian Preschool staff to apply my child’s sunscreen as needed. Parent/ Guardian Signature:____________________________________________________________ Date:__________________ BUG REPELLENT As a parent/guardian of the above child I understand my child will be playing outside, every day; weather permitting. Therefore, I give permission for the staff at Countryside Christian Adventure Club / Before & After Care to apply spray insect repellent that I the parent/guardian have provided and will be used as needed. Please initial one: _______ I allow Countryside Christian Adventure Club / Before & After Care staff to apply my child’s spray on insect repellent as needed, Must fill info below.

When is it needed and how often: ___________________________________________________________________________________________________

___________________________________________________________________________________________________ Directions to apply spray Sunscreen: ___________________________________________________________________________________________________

___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _______I choose NOT to allow Countryside Christian Adventure Club / Before & After Care staff to apply my child’s sunscreen as needed. Parent/ Guardian Signature:____________________________________________________________ Date:__________________

OTHER: (non-medication creams/lotions, etc.) As a parent/guardian of the above child I understand my child may need______________________________________________________. Please initial: _______ I allow Countryside Christian Adventure Club / Before & After Care staff to apply ________________________________________ to my child as needed which is stated in the directions on the container. Must fill out when it’s needed, how often and directions to apply.

Directions to apply ________________________________________________on my child: ___________________________________________________________________________________________________

___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Parent/ Guardian Signature:____________________________________________________ Date:__________________

ADVENTURE CLUB

Child Permission Form for movies / field trips Child’s Full Name: __________________________________________________________________ ***Please make additional Copies for additional Children***

CAMP MOVIE POLICY: I understand that we may view “G” and “PG” rated movies while at Adventure Club or on a field trip. FIELD TRIP PERMISSION: I give my consent for my Child _________________________________________, to go on any field trip with Adventure Club Countryside Christian Center, to make incidental stops en route and return as may be necessary. I will be notified in writing 24 hours in advance of the designated site of the field trip including necessary details. I hereby assume full responsibility; waive all claims and release and hold, Countryside Christian Center, Adventure Club, its officers, agents, and employees harmless from any and all liability claims, which may arise out of or in connection with my child’s participation in this activity. I authorize camp representatives to obtain medical treatment for my child in case of illness or injury and agree to pay for any expense incurred for this treatment. I fully understand that campers are to abide by all rules and regulations governing conduct during the trip. Any violation of these rules may result in a child’s removal from part or all of the field trip and the parent / guardian may be notified to pick their child up from the field trip location. I hereby assume full risk for any and all damages, injuries (including death), or losses that I may sustain or incur, if any, for ourselves and the above named children, while attending, engaging, practicing, participating or witnessing , or any other activity and/or certain event(s) occurring in or about the premises or at any offsite location. I hereby assume full responsibility, waive all claims and release and hold, Countryside Christian Preschool, Adventure Club, Countryside Christian Center, Countryside Christian Academy, Inc., or its affiliated entities, its instructors, members, employees, executors or partners of said program or event, individually or otherwise, harmless for any and all liability claims, suits, damages, expenses, fees, actions, or rights of action or judgments as a result of injury or death to myself or members of my family or heirs, or my guests, or damage, destruction or loss to my property, which in any way relates to, arises out of, or is in any way connected with my presence on the premises, or my participation in events of activities thereon, including transportation to and from said activity, or the negligent acts or omissions of the releasees or any other third party. I am fully aware and understand that Adventure Club, Countryside Christian Preschool, Countryside Christian Center, Countryside Christian Academy, Inc., or its affiliated entities, does not have on or about the premises, or employ or contract with any medical services, provisions for ordinary or emergency medical service. I understand that in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be contacted, I give my permission to the staff or sponsor to secure the services of a licensed physician to provide the care necessary, including anesthesia, for the above named children. In consideration of my participation in and the use of the Adventure Club, Countryside Christian Preschool, Countryside Christian Center, Countryside Christian Academy, Inc., or its affiliated entities, premises or facilities, I herby release and covenant not to sue the owner of the premises (releasees) shareholders, directors, officers, employees, representatives, agents, affiliated and lessees from any and all claims resulting from any physical injury that may occur to me while participating in any program or even sponsored by Adventure Club, Countryside Christian Preschool, Countryside Christian Center, Countryside Christian Academy, Inc., or its affiliated entities. I understand that the field trips or activity will be supervised by adults, and I also understand that my son/daughter will be responsible for all his/her expenses connected with the trip. Siblings and/or extended family member or friends may not attend the trip(s). I have read and fully understand the above release/waiver and fully understand that I have given up substantial rights by signing the waiver voluntarily. *** SIGN IN BELOW IN THE PRESENCES OF A NOTARY**** *Parent/Guardian Name (print): ____________________________________________________________ Date:___________________________ *Address: ________________________________________________________________ *Phone Number: _______________________________

**Sign in the presence of a Notary** Signature: ____________________________________________________________________________ Date: ___________________________

**Sign in the presence of a Notary**

STATE OF FLORIDA: COUNTY OF PINELLAS The foregoing instrument was acknowledged before me this ________________ day of __________________________________, 2018

by_____________________________________, who is _____ personally known to me or ______ has produced the following identification - State

Issued ID #: _______________________________ Other ID #:____________________________. Notary Stamp or Seal:

_________________________________________ Signature of Notary Public

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ADVENTURE CLUB SNACK SHACK

Snack Account Snack account is great way for your child to get fun snacks without having your child carry cash. It is

also a great way to provide snacks for your child(ren) while they are at Adventure Club. All Proceeds

earned from the snack account will be used to get new materials for games, equipment and special

activities for Adventure Club.

We will have a morning and afternoon snack period where children may have a snack:

AM Snack: If your child needs to have a snack, your child may bring something from home or they may purchase from a snack from our Snack Shack starting at 8:00. All snacks must be finished by 9:00am

PM Snack: We will provide one free PM snack that will consist of either animal crackers, pretzels, popcorn, applesauce or a mixed fruit. They may also buy snacks from our Snack Shack.

You may open a snack account for your child and add cash to your child account when needed, as the account is running low, you may fill it as needed. If your child has a specific snack or nutrition need please see an office staff with details (your child may bring their own snacks from home). As your child purchases snack we will deduct the amount from the snack account. Snack Shack will have many items where children may purchase snacks every day for .50 each and on Friday’s we will offer the .50 snacks and may offer ice cream bars and special treats for $1.00 each. Some of our snack packages are but not limited to: Apple Sauce cups, Variety of Chips, Gold fish, Juice Boxes, Chees-its, Fritos, Cheetos, Rice Krispy Treats, Cookies, Etc.

Each snack is $ .50 cents , except on Friday’s when we offer ice creams and/or special treats which

are $1.00 each.

If you would like your child to purchase snacks please fill out the form on the back and return to the

office with the snack money in an envelope with the child’s full name on the envelope. .

------------------------------------------------------------------------------------------------------------------------------------------------

Child’s Information: ________________________ __________________________ Grade:__________

First Name Last Name

Amount of cash enclosed: $___________________________________

For questions call 727-799-1618 x 1012

Adventure Club Snack Shack Account Grade:______

Child’s Information: _________________________________ __________________________________

First Name Last Name

**ALLERGY**:_______________________________________________________________________________

Special Instructions:________________________________________________________________________________

________________________________________________________________________________________________ __________________________________________________________________________________________________________

Days child may purchase snack: □ Everyday / □ Monday □ Tuesday □ Wednesday □ Thursday □ Friday

Initial Date Total -/+ $ Initial Date Total -/+ $ Initial Date Total -/+ $


Rules and Regulations for Adventure Club

Parents please initial the bottom each page after your have read it and sign the last page, stating that you have read and agree to the fees, policies, procedures, and releases described in this

packet. Also that you fully understand, and have explained to your child the Code of Conduct including the behavior that is expected and the disciplinary actions / consequences if not upheld.

1. Camp Hours: Camp sessions are from 6:30 AM to 6:00 PM. Camp closes promptly at 6:00 PM. Starting at 6:01 PM,

late fees are $1.00 per minute / per child. Our 6:00 PM closing time is strictly enforced and payment in cash is

due at time of pickup or next morning before you are allowed to drop off. 2. Camp Fee Policy: At registration, a non-refundable program registration fee of $50.00 for campers.

a. Spaces are not guaranteed until you have returned your fully completed application forms, weeks are

checked, registration fee, and your first week’s camp tuition are submitted. Advanced multiple week

payments are welcomed.

b. There is NO REFUND of camp tuition for unused days or weeks. Since spaces are limited, you are obligated to pay for ALL WEEKS YOU HAVE SIGNED YOUR CHILD UP FOR. We cannot give

compensation or refunds for absences due to illness, vacation, holidays, camp closures, or any other reason.

c. Your child’s spot is only guaranteed for the weeks that are checked, If you need additional weeks, you must check with the AC office staff, available spots are on first come basis. We can only take 50 students weekly.

d. Automatic withdrawal is the method of payment. It will be processed each Monday. Tuition is collected weekly, each Monday that your child is registered. It is important that any if

cancelations occur for any reason, no refunds will be given. e. There is a $10.00 fee if payment is not received by the close of business on the Monday of the current

camp week. WE RESERVE THE RIGHT TO REFUSE A CAMPER WHOSE TUITION IS NOT CURRENT. f. There will be a $50.00 fee for all returned payments. Families may be placed on CASH ONLY payment if

this happens more than once. Tuition and fees may give to Office or given to the morning check-in staff.

2. Changes to Field Trips: Weekly field trips may be changed due to weather, scheduling conflicts with the trip

provider, illness, transportation problems, or other factors beyond our control. NO REFUND WILL BE GIVEN DUE TO

FIELD TRIP CHANGES. The canceled trip may be replaced with another trip or special event on another day.

3. Lunch: Campers who will be at the camp all day must bring a packed lunch from home. On occasion, the camp will provide a lunch or at certain field trips. Parents will be notified ahead of time. Parents will be notified if a camper is brought to camp without a lunch. Campers who do not notify their group leader until lunchtime, that they do not have a lunch will receive a PB&J, chips and water or something similar. A $6 fee will be added to your account. If this occurs more than 3 times during the summer the fee will increase to $10 per instance.

4. Water Bottle: It is mandatory that each child brings a water bottle every day. We will take many water breaks while

outside. The child will be responsible of their own water bottle. On field trip days it would be best to send a disposable water bottle. Please write your child’s name on their bottle.

5. Snacks: A free snack is provided every day in the PM. Students may bring a morning snack from home (if desired)

which should be consumed before Opening Session at 9:00 AM. We will also have a Snack Shack where children may purchase snacks every day in the AM or PM for .50 each for normal snacks. We may have a few days where we offer special snacks like donuts, popcorn, or other treats that will be $1.00, plus on Friday’s we will offer ice cream bars for $1.00 each. You may open a snack account for your child and add money to it as it is needed. If your child has a specific snack or nutrition need please see an office staff with details.

6. Arrival and Departure Procedure: Parents or guardians MUST ENTER the building to sign your child IN and

OUT. This procedure is for your child’s safety and is our only time to get you updated camp information or field trip changes as necessary. STUDENTS WILL NOT BE ADMITTED TO CAMP WITHOUT PARENT / GUARDIAN SIGN IN! Children will be released only to persons authorized by parents or guardians as listed on the enrollment forms. All persons picking up children should carry Photo Identification as it will be required if that person is not known by the staff on site.

_____________PARENT INITIAL


Registration Packet Rules and Regulations

7. Camp Shirts: Camp T-Shirts MUST be worn on ALL non-swimming FIELD TRIPS. If your child is not wearing his /

her assigned t-shirt an additional t-shirt will be issued. Current year camp t-shirts will be $8.50. The cost of the shirt will be billed to your account. Field trip days will be outlined on your weekly @ A Glance Calendar.

8. Field Trip Departure: Departure times will be posted on the Week @ A Glance Calendar. Please make sure that your

child is here at the appropriate time indicated on that schedule. We will depart on time. Any campers arriving late may not make their field trip. Field trip transportation needs are determined at the time of departure. If your child is not present at the time of departure, the camp considers them absent for the day unless prior accommodations have been arranged through the camp office. Therefore, campers will not be allowed to be dropped off at any field trip site. Return times posted on your Camp Activity Schedule may vary due to traffic or safety concerns beyond our control. Should extreme delays occur you will be notified as soon as possible by phone.

9. Dress Code: As we are a Christian summer camp we expect campers to dress moderately and appropriately. Please

no spaghetti straps or mid-drift tops. Tops must be loose fitting and be an appropriate length. Skirts and shorts should be of a moderate length, going to at least mid thigh. Generally speaking, shorts going to the end of your child’s fingertips would be appropriate. Clothing should be worn as manufactured (not rolled up on the waistband or legs). Shirts may only be “banded” with a rubber band or hair tie if NO PORTION OF THE STOMACH is being revealed. Clothing should not have printing or graphics on it that is inappropriate for a Christian summer camp. WE RESERVE THE RIGHT TO REFUSE A CAMPER WHOSE DRESS IS INAPPROPRIATE.

10. Change of Clothes: Younger campers and those campers prone to bathroom accidents are strongly encouraged to

bring a change of clothes with them to camp. If your child has an accident and does not have a change of clothes with him / her, the parents will be called to bring clothes or pick up the child. If you bring extra clothes please put them in a gallon size zip lock bag and write the child’s full name on it and store in their bag.

11. Swim Apparel / Swim Guidelines: Swimming apparel is to be modest. ALL GIRL’S BATHING SUITS should be

ONE PIECE ONLY regardless of age. If your child does not own a one-piece bathing suit, a dark colored t-shirt must be worn over any bikini or two-piece swimsuit at all times. Girls without a dark colored t-shirt to wear over their two-piece swimsuit will be issued a camp shirt and a $8.50 fee will be charged to your account. Boys’ bathing suits should be board shorts or long shorts, please. Campers not wearing appropriate swimming apparel may be restricted from swimming. It is mandatory that each camper wear and bring their personal sunblock daily.

12. Sun Block: It is mandatory that each camper wear their sunblock before arriving at camp and they need to bring their

personal sunblock daily. On outdoor field trips, trips to the pool or water days children MUST bring their sunblock, if no sun block is provided your child may not be able to participate. We cannot allow campers to share sun block due to possible allergies. If your child cannot apply his or her own sun block, please provide a spray or aerosol type. Camp staff can only help apply these 2 types.

13. Personal Property: Adventure Club allows campers to bring money on selected field trips (your Week @ A Glance

Calendar will notate which field trips it is appropriate to bring money on); Please put your child’s money in an envelope with their FULL NAME, age, date and the amount of money in the envelope, Also, please write any special instructions on the envelope. Depending on the itinerary and current staff, campers may or may not have the opportunity to spend said monies.

14. Cell Phones: Please do not allow campers to bring cell phones to camp. They will have no need for them while

they are here and all staff will have a cell phone and/or another communication device in case of emergency. Campers who bring a cell phone to camp will be told to TURN IT OFF (NOT ON VIBRATE), put it away with their belongings, and asked not to bring it back to camp. Any camper not complying with the above rules WILL HAVE THEIR CELL PHONE CONFISCATED and returned to the parent at the time of pickup. Campers who continue to disobey the cell phone policy will face the discipline action stated in the Code of Conduct below.

15. Faith Content: Adventure Club is a Christian summer camp and a ministry of Countryside Christian Church.

While at camp, children will encounter a level of exposure to the Christian faith and its values.

_____________PARENT INITIAL


Registration Packet Rules and Regulations

16. Code of Conduct: Adventure Club’s goal is to offer a safe, enriching experience for all students in a loving Christian environment. Reasonable rules and regulations are essential to ensure each child’s safety and allow each child to experience the full enjoyment of our program. PLEASE REVIEW THE CAMP’S CODE OF CONDUCT AND DISCIPLINE POLICY WITH YOUR CHILD.

a. Student will stay with camp staff in assigned activity area & must have consent from staff to go to another area.

b. Student will show courtesy, respect, and good manners toward fellow students and staff members.

c. Student will use appropriate language and manners; NO profane or inappropriate language or gestures. d. Student will keep hands and feet to themselves. No kicking or hitting. NO FIGHTING.

e. Student will be respectful of property belonging to the center and fellow students. As well as the property at any of

our field trips. Parent / Guardian will be responsible for payment of any damaged or destroyed property.

f. Good sportsmanship and fair play must be displayed at all times.

g. Violent toys or instruments will not be allowed.

h. Student will abide by all bus / van safety rules: 1. Student is to remain seated and have SEAT BELT BUCKLED AT ALL TIMES. 2. Student will exit bus / van ONLY as the driver or staff member directs. 3. Student will remain in assigned loading area and will not enter bus / van until the driver or camp staff

member indicates it is safe to do so. 4. A quiet voice will be used at all times. 5. Student will sit in assigned seat if designated or if the driver appoints one.

FAILURE TO OBEY THE RULES MAY RESULT IN THE FOLLOWING PROGRESSION OF DISCIPLINARY ACTION: a. Students will be given two verbal reprimands.

b. A third verbal reprimand will be accompanied by a period of “time out”/ quite play (in view of staff member), which

may include partially missed time on a field trip or during a special activity.

c. A student conference with the director and / or a written notice requiring a parent / guardian signature will be issued. In addition, a field trip or special activity may be taken away.

d. After three written notices or student conferences, a parent conference with the director may be scheduled.

e. When it is deemed necessary by the director, parent / guardian may be called to take the student home.

f. Student may be suspended from the program for a time period to be determined by the director. g. If the student cannot be kept safe in our care, the student is jeopardizing the safety of other students in our care,

or all other prior discipline measures have been exhausted and failed, the student may be expelled from the program at the discretion of the Camp Director and church Business Administrator.

h. Any behavior that is deemed malicious, bulling, harassing, violent, results in physical harm and / or

property damage may result in advanced stages of discipline, including, but not limited to, immediate suspension and recommendation for expulsion from the program (to be determined by Camp Director and the church Business Administrator).

Adventure Club and its staff reserve the right to implement any of the above steps deemed necessary, based on the severity of the behavior. 17. Photo Release: As parent and / or legal guardian, I give permission to Countryside Christian Center and any of its

ministries or aliases (Adventure Club, etc.) to reproduce and publish photographs taken of my child for any necessary or appropriate camp or church related publicity purposes.

18. Liability Release: As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the

above named minor (“student”). I, in my own behalf and on behalf of the student, agree to release and to hold harmless Countryside Christian Church,Inc. Adventure Club, and any affiliates, their respective directors, officers, representatives, ministers, members, agents, employees and volunteers from any and all liability for negligence or any other claim judgment, loss, cost and expenses arising out of or connected with attendance at Adventure Club, and any claim arising out of or connected with any illness or injury that Minor may incur or sustain during the program, all field trips and activities associated with the program, and while traveling to and from Adventure Club

I have read and agree to the fees, policies, procedures, and releases described in this packet. I have also reviewed, fully understand, and have explained to my child the Code of Conduct including the behavior that is expected and the disciplinary actions / consequences if not upheld. Parent/Guardian Signature: _______________________________________ Date: _____________

Student Code of Conduct Student:

I, _____________________________________________, understand and will follow the “Student Code of Conduct” which are the Adventure Camp Rules. Adventure Club’s goal is to offer a safe, enriching experience for all students in a loving Christian environment. These rules and guidelines are needed to ensure each child’s safety and allow each child to experience full enjoyment of our program. If I break these rules I understand that there are consequences for my actions and disciplinary actions will take place. PARENTS PLEASE REVIEW THE PROGRAM’S CODE OF CONDUCT AND DISCIPLINE POLICY WITH YOUR CHILD.

1. I will stay with the teacher in assigned activity area and must have permission from staff to go to another area. 2. I will show courtesy, respect, and good manners toward fellow students, staff members and to others outside of our

program. 3. I will listen and follow directions given by any of our group leaders / camp staff. 4. I will use appropriate language and manners; NO inappropriate language and/or gestures. 5. I will keep hands and feet to myself. I understand that fighting is NOT tolerated at Adventure Club. 6. I will be respectful of property belonging to others. As well as the property at camp and any of field trip locations. Parent

/ Guardian will be responsible for payment of any damaged or destroyed property. 7. I understand that good sportsmanship and fair play must be displayed at all times. 8. I understand that I cannot bring any outside toys. 9. I will abide by all bus / van safety rules:

a. I will remain seated and have SEAT BELT BUCKLED AT ALL TIMES. b. I will exit bus / van ONLY as the driver or staff member directs. c. I will stay in assigned loading area and will not get on or off the van/bus until told to do so. d. I will use a quiet inside voice while in the van. e. I will sit in assigned seat if designated or if the driver appoints one.

FAILURE TO OBEY THE ABOVE RULES MAY RESULT IN THE FOLLOWING PROGRESSION OF DISCIPLINARY ACTION:

1. I will be given two verbal warnings / and talked to by staff. 2. A third verbal warning and will be accompanied by a period of “time out” (in view of staff member) which may

include partial missed time on a field trip or during a special activity. 3. A student conference with the Director and/or… 4. A written notice requiring a parent / guardian signature will be issued. 5. A field trip or special activity may be taken away or the student may be moved to another class or group for a

period of time to be determined by the Director. 6. Depending on the child’s behavior and/or after three written notices or student conferences, a parent

conference with the Director may be scheduled. 7. When it is deemed necessary by the Director, parent / guardian may be called to take the student home. 8. Student may be suspended from the program for a time period to be determined by the Director. 9. If the student cannot be kept safe in our care, the student is jeopardizing the safety of other students in our

care, or all other prior discipline measures have been exhausted and failed, the student may be expelled from the program at the discretion of the Adventure Club Director and the Church Business Administrator

10. Any behavior that is deemed hateful, mean, bulling, harassing, violent, results in physical harm and / or property damage may end in advanced stages of discipline, including, but not limited to, immediate suspension and recommendation for dismissal from the program.

Child’s: Signature:_____________________________________________________ Date:__________________________ Parent: I, _________________________________, as parent or guardian of ___________________________________ have reviewed the conduct and discipline policy with my child and they understand the conduct, rules and disciplinary actions of Adventure Club program. By signing we both understand that ADVENTURE CLUB and its staff reserves the right to implement any of the above steps deemed necessary, based on the severity of the behavior or actions taken by the student. Parents Name:__________________________________ Parents Signature:____________________________________ Date:__________________________

During the 2009 legislative session, a new law was passed that requires child care facilities, family day care homes and large family child care homes provide parents with information detailing the causes, symptoms, and transmission of the influenza virus (the flu) every year during August and September.My signature below verifies receipt of the brochure on Influenza Virus, The Flu, A Guide to Parents:

Name: ________________________________

Child’s Name: ________________________

Date Received: _______________________

Signature: ____________________________

Please complete and return this portion of the brochure to your child care provider, in order for them to maintain it in their records.

What should I do if my child gets sick?Consult your doctor and make sure your child gets plenty of rest and drinks a lot of fluids. Never give aspirin or medicine that has aspirin in it to children or teenagers who may have the flu.

CAll oR TAke youR ChIlD To A DoCToR RIGhT AWAy IF youR ChIlD:

• Has a high fever or fever that lasts a long time• Has trouble breathing or breathes fast• Has skin that looks blue• Is not drinking enough• Seems confused, will not wake up, does not

want to be held, or has seizures (uncontrolled shaking)

• Gets better but then worse again• Has other conditions (like heart or lung

disease, diabetes) that get worse

What can I do to prevent the spread of germs?The main way that the flu spreads is in respiratory droplets from coughing and sneezing. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and infect someone nearby. Though much less frequent, the flu may also spread through indirect contact with contaminated hands and articles soiled with nose and throat secretions. To prevent the spread of germs:

• Wash hands often with soap and water.

• Cover mouth/nose during coughs and sneezes. If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.

• Limit contact with people who show signs of illness.

• Keep hands away from the face. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

When should my child stay home from child care?A person may be contagious and able to spread the virus from 1 day before showing symptoms to up to 5 days after getting sick. The time frame could be longer in children and in people who don’t fight disease well (people with weakened immune systems). When sick, your child should stay at home to rest and to avoid giving the flu to other children and should not return to child care or other group setting until his or her temperature has been normal and has been sign and symptom free for a period of 24 hours.

For additional helpful information about the dangers of the flu and how to protect your child, visit: http://www.cdc.gov/flu/

how can I protect my child from the flu? A flu vaccine is the best way to protect against the flu. Because the flu virus changes year to year, annual vaccination against the flu is recommended. The CDC recommends that all children from the ages of 6 months up to their 19th birthday receive a flu vaccine every fall or winter (children receiving a vaccine for the first time require two doses). You also can protect your child by receiving a flu vaccine yourself.

INF

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zA

VIR

uS

INF

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“The Flu” A Guide

for Parents

For additional information, please visit www.myflorida.com/childcare or contact your

local licensing office below:

This brochure was created by the Department of Children and Families in consultation with the Department of Health.

CF/PI 175-70, June 2009

What is the influenza (flu) virus?Influenza (“the flu”) is caused by a virus which infects the nose, throat, and lungs. According to the US Center for Disease Control and Prevention (CDC), the flu is more dangerous than the common cold for children. Unlike the common cold, the flu can cause severe illness and life threatening complications in many people. Children under 5 who have the flu commonly need medical care. Severe flu complications are most common in children younger than 2 years old. Flu season can begin as early as October and last as late as May.

how can I tell if my child has a cold, or the flu? Most people with the flu feel tired and have fever, headache, dry cough, sore throat, runny or stuffy nose, and sore muscles. Some people, especially children, may also have stomach problems and diarrhea. Because the flu and colds have similar symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

We are excited to offer the safety, convenience and ease of Tuition Express®—a payment processing system that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT and CREDIT CARD

I (we) hereby authorize (business name) ____________________________________________ to initiate credit card charges to the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments. Check with the center for accepted credit card types.

COMPLETE ONE SECTION ONLY

SECTION A (Credit Card)

_______________________________________________________________________________________________________Cardholder Name Phone #

_______________________________________________________________________________________________________Cardholder Address City State Zip _______________________________________________________________________________________________________Account Number Expiration Date

_______________________________________________________________________________________________________ Cardholder Signature Date

SECTION B (Bank Account)

_______________________________________________________________________________________________________Your Name Phone #

_______________________________________________________________________________________________________Address City State Zip

_______________________________________________________________________________________________________ Bank or Credit Union Name Bank or Credit Union Address City State Zip

_______________________________________________________________________________________________________Routing Transit Number (see sample below) Account Number (see sample below)

_______________________________________________________________________________________________________Authorized Signature Date

Automated Payment Processing Safe – Convenient – Easy

For Official Use Only

Date Received

________________________

Employee Signature

________________________

A service of

Checking Savings

Copyright Procare Software 1/19/2015

We are excited to offer automatic payments through Tuition Express. It is no longer necessary for you to write a check for tuition and fees. Your bank or credit card account will be safely and securely debited by Tuition Express. You can be emailed a receipt for each transaction. It’s easy to sign-up – just ask us.

Frequently Asked Questions

PARENT FAQS

When I pay my tuition automatically, how secure is my account information?Very secure – more secure than when you writechecks. The checks you write every day have your name, address, phone number, and sometimes your driver’s license number on them. With this information, criminals have all they need to access your account or worse, steal your identity. Automatic payments greatly reduce this potential problem by limiting the amount of information available and who has access to it. Tuition Express also incorporates additional security procedures, utilizing 128 bit encryption.

What if the childcare center makes a mistake and takes out too much money?Report the error to your childcare center immediately – it was most likely an honest mistake. The childcare center will then adjust your account accordingly.

What if my childcare center and I disagree about a payment?If you feel that the payment should not have been made, you have the right to dispute the charge. Contact your bank or credit card company. Tuition Express and your childcare provider will work closely to resolve the issue in a timely manner.

Does this form of payment give the childcare center access to my account?Nobody at the childcare center has access to your account. When you sign up for Tuition Express, you only authorize your bank or credit card company to release the exact amount owed to your provider when it is due and payable.

How will I know when a payment was taken out of my account?Your childcare expenses will be taken out of your account on a schedule that you and the childcare center agree upon. Your childcare center has the ability to print statements for your records prior to the withdrawal of any money. Additionally, the charges will show up on your monthly statement as “Tuition Express”.

When I sign up for Tuition Express, how will thishelp my childcare provider?Your childcare provider has chosen to offer Automatic Payments for several reasons. First, it will give you the convenience of not having to write a check every time tuition and fees are due. Second, it allows regular scheduling of your payments. Most importantly, Automatic Payments reduce the amount of time your childcare center spends on management activities, giving staff more time to spend with the children.

How do I get started?Simply complete the “Payment Authorization” form and return it to your childcare provider. They will do the rest! For more information on automatic payments, visit www.directpayment.org. This is an excellent resource explaining the system and its benefits.

Where can I learn more?For more information on the benefits of Tuition Express, please visit us at www.tuitionexpress.com.

Copyright Procare Software 04-05-2013

Convenient and SafeOn-time Payments

®

QUALITY CHILD CARE

Quality child care offers health, social, and Educational experiences under qualified Supervision in a safe, nurturing and stimulating environment. Children in these settings participate in daily, age-appropriate Activities that help develop essential skills, Build independence and instill self-respect. When evaluating the quality of a child care Setting, the following indicators should be Considered:

QUALITY CAREGIVERS Are friendly and eager to care for children. Accept family cultural and ethnic differences. Are warm, understanding, encouraging and responsive to each child’s individual needs. Use a pleasant tone of voice and frequently

hold, cuddle and talk to the children. Help children manage their behavior in a

positive, constructive and non-threatening manner.

Allow children to play alone or in small

groups. Are attentive to and interact with the children. Provide stimulating, interesting and

educational activities. Demonstrate knowledge of social and

emotional needs and developmental tasks for all children.

Communicate with parents.

QUALITY ENVIRONMENTS

Are clean, safe, inviting, comfortable, child-

friendly.. Provide easy access to age-appropriate toys. Displays children’s activities and creations.

Provide a safe and secure environment that

fosters the growing independence of all children.

QUALITY ACTIVITIES Are children initiated and teacher facilitated. Include social interchanges with all children. Are expressive including play, painting,

Drawing, storytelling, music, dancing and Other varied activities.

Include exercise and coordination development.

Include free play and organized activities. Include opportunities for all children to read,

explore, and problem-solve.

PARENT’S ROLE

A parent’s role in quality child care is vital: Inquire about the qualifications and

experience of child care staff, as well as staff turnover.

Know the children’s center policies and

procedures. Communicate directly with caregivers. Visit and observe the children’s center. Participate in special activities, meetings, and

conferences. Talk to your child about their daily

experiences in the children’s center. Arrange alternate care for a sick child.

Familiarize yourself with the child care

standards used to license the children’s center.

PINELLAS COUNTY CHILDREN’S CENTERS

GENERAL INFORMATION

For a listing of children’s centers, contact 211 Tampa Bay Cares at 2-1-1. For an appointment to review a children's center file or to file a complaint contact the Child Care Licensing Program at (727) 507-4857. For further information about child care in Florida or to view children’s center inspection reports, visit the website:

MyFLFamilies.com/ChildCare

Our mission is to protect, promote & improve the health of all people in Florida through integrated

state, county and community efforts.

The statewide toll-free telephone number for reporting child abuse is 1-800-96 ABUSE (1-800-962-2873). Reports of suspected and actual cases of child physical abuse, sexual abuse, and neglect received through the Abuse Registry number are referred to the Pinellas County Sheriff’s Department for investigation.

KNOW YOUR

CHILD’S

CHILDREN'S

CENTER

Nursery School Kindergarten

Day Nursery School Age Center

PINELLAS COUNTY LICENSE BOARD for Children’s Centers and Family Child Care Homes

8751 Ulmerton Road, Suite 2000

Largo, FL 33771 Telephone 727-507-4857

www.pclb.org

The Child Care Licensing Program and its services

are funded by the Juvenile Welfare Board, the

Florida Department of Children and Family Services

and the Florida Department of Health, Pinellas

County.

C-0002 (Rev.08/16)

PINELLAS COUNTY CHILDREN’S CENTERS LICENSING STANDARDS

This children’s center has met regulations found in Licensing Regulations Governing Pinellas County Children’s Centers. A valid temporary permit or license, which bears the distinctive seals of Pinellas County and the Florida Department of Children and Family Services, is posted in a conspicuous place within the center. A valid temporary permit or license will also include: effective and expiration dates, a license number, capacity and ages of children in care.

A LICENSED CHILDREN’S CENTER MUST: Adhere to its licensed capacity at all times. Post a schedule of daily activities. Have first aid and emergency procedures, and

post evacuation diagrams in each room. Keep accurate, current daily attendance records

and document a visual sweep of the entire premises at the end of each day.

Provide parent(s) or legal guardian(s) access to

the children’s center during normal hours of operation.

Report suspected child abuse to the statewide toll-

free telephone number. Provide a permission form for parent(s) or legal

guardian(s) to allow the center to administer medication as necessary.

Document required information when

administering medication. Document accidents and incidents and obtain

parent’s, legal guardian’s or authorized pick-up person’s signature(s).

Maintain vehicles in safe condition if transportation

is provided. Obtain parent’s or legal guardian’s permission

before transporting children. Maintain contact information for children in

vehicles being used for transport and emergency care plans for children with chronic medical conditions.

CHILDREN’S RECORDS REQUIREMENTS

The following documentation is required to be maintained in the children’s center for each child in care: A signed statement that parent or legal guardian

received a copy of this brochure. A statement signed by parent or legal guardian

that enrollment information is complete and accurate.

A signed statement that the children’s center has

provided parent(s) or legal guardian(s) a copy of the written disciplinary practices.

A current health examination record (not required

for school age children). A current Florida Certificate of Immunization (not

required for school age children). A notarized Emergency Medical Release. Medical records that include special medical or

dietary needs and a list of allergies, if applicable. Primary hours of care and days of week in care. Telephone numbers or instructions as to how to

reach parent(s) or legal guardian(s) when children are in care.

Hospital preference. Child’s full, legal name, birth date, date of

enrollment, current address and preferred name/nick name.

Name, address, and telephone number of parent

or legal guardian. Name, address and telephone number of

emergency person(s), other than parent or legal guardian.

Name, address and telephone number of

physician and dentist. Proof of receipt by parent(s) or legal guardian(s)

every August and September of information regarding causes, symptoms, and transmission of the influenza virus.

PERSONNEL REQUIREMENTS Director has a Director Credential with the

certificate posted. Documentation that staff meets the staff

credentialing requirement (not required for school age centers).

Completion of background screening. Completion of 40-Hour Introductory Child Care

training. Completion of 10 hours training annually. Completion of early literacy training (not

required for school age centers). Documentation of educational requirements. Meet minimum age requirements. Signed statements that employees understand

the statutory requirement of reporting child abuse/neglect.

Staff trained in first aid and CPR on the

premises at all times and on field trips Staff maintain direct supervision including

minimum adult-child ratios: 2 months-1 year 1 adult for 3 children 1 year-2 years 1 adult for 5 children 2 year olds 1 adult for 10 children 3 year olds 1 adult for 15 children 4 year olds 1 adult for 20 children 5 years and up 1 adult for 25 children

NUTRITIONAL REQUIREMENTS Parent(s) or legal guardian(s) notified of meals provided that are of quality and quantity

to assure child’s nutritional needs are met or arrangements made for parent(s) or legal guardian(s) to provide nutritional food. o Posted meal and snack menus. o Safe drinking water is available.

PHYSICAL ENVIRONMENT Has sufficient indoor space for playing and

napping that is kept clean, adequately lighted, vented and in good repair.

Has indoor and outdoor space that is clean and free of litter and other hazards.

Has toys, equipment and furnishings that are

age and developmentally appropriate, and are maintained in an operable, safe, and sanitary condition.

Has appropriate bathroom facilities that are

operable, clean and sanitized (daily). Has isolation area for ill children. Has equipment for proper sanitary hand

washing, toileting, and diapering activities.

Has at least one corded, operable telephone available to staff.

HEALTH RELATED ENVIRONMENTAL REQUIREMENTS

Annual approved fire inspections conducted. Monthly checks to ensure all areas of the

children’s center are free from fire hazards. Smoking is prohibited on premises. Storage of toxic and hazardous materials in

areas inaccessible to children. Fire and emergency drills conducted as

required. A labeled, fully stocked first aid kit. Parent(s) or legal guardian(s) notified of all

animals on site. Records of immunizations for animals/fowl. Prohibit fire arms or weapons on premises

(excluding federal, state and local law enforcement officers).

Prohibit narcotics, alcohol or other impairing

drugs on the premises. Bimonthly outdoor equipment maintenance

checks.


PARENT COPY - Rules and Regulations for Adventure Club

Parent copy of which you have signed that states that you have read and agree to the fees, policies, procedures, and releases described in this packet. Also that you fully

understand, and have explained to your child the Code of Conduct including the behavior that is expected and the disciplinary actions / consequences if not upheld.

1. Camp Hours: Camp sessions are from 6:30 AM to 6:00 PM. Camp closes promptly at 6:00 PM. Starting at 6:01 PM, late fees are $1.00 per minute / per child. Our 6:00 PM closing

time is strictly enforced and payment in cash is due at time of pickup or next morning before you are allowed to drop off. 2. Camp Fee Policy: At registration, a non-refundable program registration fee of $50.00 for campers.

a. Spaces are not guaranteed until you have returned your fully completed application forms, weeks are checked, registration fee, and your first week’s camp tuition are

submitted. Advanced multiple week payments are welcomed.

b. There is NO REFUND of camp tuition for unused days or weeks. Since spaces are limited, you are obligated to pay for ALL WEEKS YOU HAVE SIGNED YOUR CHILD UP

FOR. We cannot give compensation or refunds for absences due to illness, vacation, holidays, camp closures, or any other reason.

c. Your child’s spot is only guaranteed for the weeks that are checked, If you need additional weeks, you must check with the AC office staff, available spots

are on first come basis. We can only take 50 students weekly. d. Automatic withdrawal is the method of payment. It will be processed each Monday.

Tuition is collected weekly, each Monday that your child is registered. It is important that any if cancelations occur for any reason, no refunds will be given. e. There is a $10.00 fee if payment is not received by the close of business on the Monday of the current camp week. WE RESERVE THE RIGHT TO REFUSE A CAMPER

WHOSE TUITION IS NOT CURRENT. f. There will be a $50.00 fee for all returned payments. Families may be placed on CASH ONLY payment if this happens more than once. Tuition and fees may give to Office

or given to the morning check-in staff.

2. Changes to Field Trips: Weekly field trips may be changed due to weather, scheduling conflicts with the trip provider, illness, transportation problems, or other factors beyond our

control. NO REFUND WILL BE GIVEN DUE TO FIELD TRIP CHANGES. The canceled trip may be replaced with another trip or special event on another day.

3. Lunch: Campers who will be at the camp all day must bring a packed lunch from home. On occasion, the camp will provide a lunch or at certain field trips. Parents will be notified ahead of time. Parents will be notified if a camper is brought to camp without a lunch. Campers who do not notify their group leader until lunchtime, that they do not have a lunch will receive a PB&J, chips and water or something similar. A $6 fee will be added to your account. If this occurs more than 3 times during the summer the fee will increase to $10 per instance.

4. Water Bottle: It is mandatory that each child brings a water bottle every day. We will take many water breaks while outside. The child will be responsible of their own water bottle. On

field trip days it would be best to send a disposable water bottle. Please write your child’s name on their bottle.

5. Snacks: A free snack is provided every day in the PM. Students may bring a morning snack from home (if desired) which should be consumed before Opening Session at 9:00 AM.

We will also have a Snack Shack where children may purchase snacks every day in the AM or PM for .50 each for normal snacks. We may have a few days where we offer

special snacks like donuts, popcorn, or other treats that will be $1.00, plus on Friday’s we will offer ice cream bars for $1.00 each. You may open a snack account for your child and add

money to it as it is needed. If your child has a specific snack or nutrition need please see an office staff with details. 6. Arrival and Departure Procedure: Parents or guardians MUST ENTER the building to sign your child IN and OUT. This procedure is for your child’s safety and is our only time to

get you updated camp information or field trip changes as necessary. STUDENTS WILL NOT BE ADMITTED TO CAMP WITHOUT PARENT / GUARDIAN SIGN IN! Children will be

released only to persons authorized by parents or guardians as listed on the enrollment forms. All persons picking up children should carry Photo Identification as it will be

required if that person is not known by the staff on site.

7. Camp Shirts: Camp T-Shirts MUST be worn on ALL non-swimming FIELD TRIPS. If your child is not wearing his / her assigned t-shirt an additional t-shirt will be issued. Current year

camp t-shirts will be $8.50. The cost of the shirt will be billed to your account. Field trip days will be outlined on your weekly @ A Glance Calendar.

8. Field Trip Departure: Departure times will be posted on the Week @ A Glance Calendar. Please make sure that your child is here at the appropriate time indicated on that schedule. We

will depart on time. Any campers arriving late may not make their field trip. Field trip transportation needs are determined at the time of departure. If your child is not present

at the time of departure, the camp considers them absent for the day unless prior accommodations have been arranged through the camp office. Therefore, campers will not be

allowed to be dropped off at any field trip site. Return times posted on your Camp Activity Schedule may vary due to traffic or safety concerns beyond our control. Should extreme

delays occur you will be notified as soon as possible by phone.

9. Dress Code: As we are a Christian summer camp we expect campers to dress moderately and appropriately. Please no spaghetti straps or mid-drift tops. Tops must be loose fitting

and be an appropriate length. Skirts and shorts should be of a moderate length, going to at least mid thigh. Generally speaking, shorts going to the end of your child’s

fingertips would be appropriate. Clothing should be worn as manufactured (not rolled up on the waistband or legs). Shirts may only be “banded” with a rubber band or hair tie if NO

PORTION OF THE STOMACH is being revealed. Clothing should not have printing or graphics on it that is inappropriate for a Christian summer camp. WE RESERVE THE RIGHT TO

REFUSE A CAMPER WHOSE DRESS IS INAPPROPRIATE.

10. Change of Clothes: Younger campers and those campers prone to bathroom accidents are strongly encouraged to bring a change of clothes with them to camp. If your child has an

accident and does not have a change of clothes with him / her, the parents will be called to bring clothes or pick up the child. If you bring extra clothes please put them in a gallon size

zip lock bag and write the child’s full name on it and store in their bag.

11. Swim Apparel / Swim Guidelines: Swimming apparel is to be modest. ALL GIRL’S BATHING SUITS should be ONE PIECE ONLY regardless of age. If your child does not own a one-

piece bathing suit, a dark colored t-shirt must be worn over any bikini or two-piece swimsuit at all times. Girls without a dark colored t-shirt to wear over their two-piece swimsuit will

be issued a camp shirt and a $8.50 fee will be charged to your account. Boys’ bathing suits should be board shorts or long shorts, please. Campers not wearing appropriate swimming

apparel may be restricted from swimming. It is mandatory that each camper wear and bring their personal sunblock daily.


PARENT COPY - Rules and Regulations for Adventure Club

12. Sun Block: It is mandatory that each camper wear their sunblock before arriving at camp and they need to bring their personal sunblock daily. On outdoor field trips, trips to the

pool or water days children MUST bring their sunblock, if no sun block is provided your child may not be able to participate . We cannot allow campers to share sun block due

to possible allergies. If your child cannot apply his or her own sun block, please provide a spray or aerosol type. Camp staff can only help apply these 2 types.

13. Personal Property: Adventure Club allows campers to bring money on selected field trips (your Week @ A Glance Calendar will notate which field trips it is appropriate to bring money

on); Please put your child’s money in an envelope with their FULL NAME, age, date and the amount of money in the envelope, Also, please write any special instructions on the envelope.

Depending on the itinerary and current staff, campers may or may not have the opportunity to spend said monies.

14. Cell Phones: Please do not allow campers to bring cell phones to camp. They will have no need for them while they are here and all staff will have a cell phone and/or another

communication device in case of emergency. Campers who bring a cell phone to camp will be told to TURN IT OFF (NOT ON VIBRATE), put it away with their belongings, and asked not to

bring it back to camp. Any camper not complying with the above rules WILL HAVE THEIR CELL PHONE CONFISCATED and returned to the parent at the time of pickup. Campers who

continue to disobey the cell phone policy will face the discipline action stated in the Code of Conduct below.

15. Faith Content: Adventure Club is a Christian summer camp and a ministry of Countryside Christian Church. While at camp, children will encounter a level of exposure to the Christian faith and its values.

16. Code of Conduct: Adventure Club’s goal is to offer a safe, enriching experience for all students in a loving Christian environment. Reasonable rules and regulations are essential to

ensure each child’s safety and allow each child to experience the full enjoyment of our program. PLEASE REVIEW THE CAMP’S CODE OF CONDUCT AND DISCIPLINE POLICY WITH

YOUR CHILD.

a. Student will stay with camp staff in assigned activity area & must have consent from staff to go to another area.

b. Student will show courtesy, respect, and good manners toward fellow students and staff members.

c. Student will use appropriate language and manners; NO profane or inappropriate language or gestures.

d. Student will keep hands and feet to themselves. No kicking or hitting. NO FIGHTING.

e. Student will be respectful of property belonging to the center and fellow students. As well as the property at any of our field trips. Parent / Guardian will be responsible for payment of any damaged or destroyed property.

f. Good sportsmanship and fair play must be displayed at all times.

g. Violent toys or instruments will not be allowed.

h. Student will abide by all bus / van safety rules:

1. Student is to remain seated and have SEAT BELT BUCKLED AT ALL TIMES.

2. Student will exit bus / van ONLY as the driver or staff member directs. 3. Student will remain in assigned loading area and will not enter bus / van until the driver or camp staff member indicates it is safe to do so.

4. A quiet voice will be used at all times.

5. Student will sit in assigned seat if designated or if the driver appoints one. FAILURE TO OBEY THE RULES MAY RESULT IN THE FOLLOWING PROGRESSION OF DISCIPLINARY ACTION:

a. Students will be given two verbal reprimands.

b. A third verbal reprimand will be accompanied by a period of “time out”/ quite play (in view of staff member), which may include partially missed time on a field trip or during a

special activity.

c. A student conference with the director and / or a written notice requiring a parent / guardian signature will be issued. In addition, a field trip or special activity may be

taken away.

d. After three written notices or student conferences, a parent conference with the director may be scheduled.

e. When it is deemed necessary by the director, parent / guardian may be called to take the student home.

f. Student may be suspended from the program for a time period to be determined by the director.

g. If the student cannot be kept safe in our care, the student is jeopardizing the safety of other students in our care, or all other prior discipline measures have been exhausted and

failed, the student may be expelled from the program at the discretion of the Camp Director and church Business Administrator.

h. Any behavior that is deemed malicious, bulling, harassing, violent, results in physical harm and / or property damage may result in advanced stages of discipline,

including, but not limited to, immediate suspension and recommendation for expulsion from the program (to be determined by Camp Director and the church

Business Administrator).

Adventure Club and its staff reserve the right to implement any of the above steps deemed necessary, based on the severity of the behavior. 17. Photo Release: As parent and / or legal guardian, I give permission to Countryside Christian Center and any of its ministries or aliases (Adventure Club, etc.) to reproduce and publish

photographs taken of my child for any necessary or appropriate camp or church related publicity purposes. 18. Liability Release: As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“student”). I, in my own behalf and on behalf

of the student, agree to release and to hold harmless Countryside Christian Church,Inc. Adventure Club, and any affiliates, their respective directors, officers, representatives,

ministers, members, agents, employees and volunteers from any and all liability for negligence or any other claim judgment, loss, cost and expenses arising out of or connected with

attendance at Adventure Club, and any claim arising out of or connected with any illness or injury that Minor may incur or sustain during the program, all field trips and activities associated with the program, and while traveling to and from Adventure Club

This is the parent copy of the rules and regulations, which also goes over the fees, policies, procedures, and releases along with our Code of Conduct including the behavior that

is expected and the disciplinary actions / consequences if not upheld.

summer camp - adventure club€¦ · an assortment of fun. we accept student that have completed...

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