Creative Solution Childcare Services
4645 North State Road 7, Lauderdale Lakes, FL
33319 | Building 11 | Room 341
Phone: (954) 857-4892 | Fax: (954) 735-6295
So educative, so much Fun!!
Monday thru Friday from 6:30 am to 6:30 pm.
June 12th, 2017 until August 11th, 2017
www.campcentralbroward.weebly.com
Enrollment Form (for Children ages 5 to 12)
Special Features: Pricing Information:
Healthy meals provided for all ! $ 50 Registration Fee (non refundable)
children. ! $ 6 Uniform T-Shirts
! $ 5 Late Pick Up after 6:30 PM (Per
Low counselors-campers ratios. minute per child)
Weekly themes and entertaining Payment Options, so many!
activities. Weekly $100 (you get one week vacation
Swimming Classes. without paying it)
Math, Computers, Reading Labs. Vacation week:__________________
Special enrichment activities and Drop In Rate Weekly $125 (parents may
many field trips! choose which weeks to come in)
Weekly fees include all field trips, Wk1 Wk2 Wk3 Wk4 Wk5
educational materials, attractions Wk6 Wk7 Wk8 Wk9
and meals! !
Session 1 - $325. June 12th July 1st
!
Session 2 - $325. July 3rd July 22nd
!
Session 3 - $325. July 24th Aug. 11th
! Fees must be paid in advance by Friday each week.
! Pre-payment plans are available from now!! Just ask at (954) 857-4892
! All fees are non-refundable.
Summer Camp Registration Form Received on Date:
Receipt Number:
Must be complete in full for each participant to be registered.
Received by:
PARTICIPANTS INFORMATION
Childs Name: ! Male ! Female
Age: DOB: Grade Leaving:
Street Address: City: Zip Code:
Email Address:
Mothers Full Name: Mobile #:
Fathers Full Name: Mobile #:
Guardians Full Name: Mobile #:
1. Emergency Contact: Mobile #:
2. Emergency Contact:: Mobile #:
3. Emergency Contact: Mobile #:
4. Emergency Contact: Mobile #:
HEALTH INFORMATION
Primary Care/Clinic Name: Phone #:
Child has any known allergies? ! Yes ! No If yes, specify, including medication or treatment plan.
Camper currently takes medication or requires special health care? (i.e. inhaler, EpiPen, etc.) ! Yes ! No
UPON READING THE STATEMENTS BELOW, PLEASE INITIAL NEXT TO EACH ONE.
____ Summer Camp begins at 6:30am and ends promptly at 6:30pm daily. CAMPERS WILL NOT BE ACCEPTED AFTER 9:00am.
____ I understand that payment for the Summer Camp program MUST BE PAID IN ADVANCE of the child attending camp. OUR
CENTER DOES NOT PROVIDE VACATIONS. This means that since school/camp expenses continue whether or not your child is in
attendance, no refunds or discounts are given for absences, vacation, sickness or holidays.
_____ This center will not assume responsibility for any child that has not been signed in upon arrival to school. Please make sure
you sign your child in and out daily.
____ Failure to pay in advance may result in dismissal from the program.
____ I understand that once the weekly fees are paid; there is NO REFUND OR CREDIT for day(s) the student does not attend. I
understand that the schools policy states there is absolutely NO REFUNDS for any student (s) suspended or expelled from the
program. One (1) referral will result in dismissal from the program.
____ I understand that my child will be expected to behave in accordance with the Code of Student Conduct for Broward County
Public Schools.
____ I understand that it is necessary to pick up my child/ren on time. A late pickup charge of $5.00 per minute will be assessed for
each minute after 6:30pm that the child is not picked up, due in cash at pick up time. Repeated failure to do so may result in
dismissal from the program. THREE (3) late student(s) pick-up could result in dismissal from the program.
____ I understand that it is my responsibility to keep my own records and receipts for income tax purposes.
With my signature, I hereby release and hold harmless Central Charter School, their off campus facilities and individual sponsors,
including teachers, aides, administrators and principals from all liability for mishap or injury to my child/ren while engaged in the
activities of this program. It is understood that extensive precautionary measures will be taken during the program operation. This is
to verify that I understand and agree to the above stated policies.
Parent/Guardian Signature Date
Summer Camp Registration Form Addendum
Must be complete in full for each participant to attend Camp Central.
Guiding Principles
To ensure that the rights of all individuals are protected while attending the camp.
To establish the safest and best possible learning environment for all camp participants.
To ensure that breaches of the rules and code of conduct are treated in a fair and consistent manner
Expectations
All parents and campers have the responsibility to treat one another, staff and property with respect.
All parents and campers have the responsibility to act and behave in a way which does not endanger, intimidate or
interfere with the participation of others.
Campers have the responsibility to follow the instructions given by camp staff.
All parents and campers have the responsibility to behave according to this code of conduct
and will be subject to dismissal if these rules are broken.
Rules
The following forms of behavior are considered a violation of this document and are unacceptable and could result in the
immediate dismissal of camper(s):
Using language that is offensive, sexist or racist used by either parent or camper.
Fighting, bullying or any other forms of aggressive behavior.
Leaving camp boundaries without permission.
Behaving in a manner which is potentially dangerous to self and others.
Behaving in a manner which damages or vandalizes the property of others or the Central Charter School and Creative
Solution Childcare Services campus.
Cigarettes or any tobacco products, alcohol, non-prescribed drugs, weapons and pornographic material MUST NOT be
brought to camp.
Any breach of the Rules will initiate a disciplinary action. Creative Solution Childcare Services Programs reserve the right
to suspend or dismiss a campers participation in camp activities, without refund of camp tuition, if such disciplinary action
is required. Before such a decision is fully made, the camper and parent/guardian will meet with camp coordinator to
determine the best course of action.
Agreement
I have read and agree to adhere to the above Rules during the Summer Camp. My child and I fully
understand the Rules as detailed above and I agree to him/her receiving appropriate disciplinary action
should he/she breach them:
Parent/Guardian Signature: Date:
Childs Signature: Date:
Media Release Form
I, the undersigned, do grant permission to Creative Solution Childcare Services to use the image of my child taken in
photographs, video and audio recordings as well as of recorded oral descriptions of my child and his/her projects. Such
use includes the editing, display, distribution, publication or otherwise use of said photographs, images and/or video taken
of my child for use in materials that include, and may not be limited to, school website, printed materials such as
brochures, newsletters, videos and digital images.
Parent / Guardian Signature:
