Calvary Summer Session

One Child	Two Children	Three Children
$170	$330	$475

One Child

Two Children

Three Children

$170

$330

$475

Parent / Guardian Name

Street Address

Apartment / Unit Number

City

State

Zip Code

Parent or Guardian Primary Phone Number

i.e. cell or home - whichever would be most be to reach you during the day

Parent or Guardian Work Phone Number

Second Parent or Guardian Primary Phone Number

i.e. other parent or custodial caretaker's cell phone

Parent or Guardian's Email Address

Second Parent or Guardian's Email Address

Children's Information

Complete this section for each of the children you are enrolling. You may use this form for up to 4 children who live with you. If you need to enroll more than 4 children you will need to complete another registration form, but you will not be charged 2 registration fees.

Child 1

CHILD 1: First and Last Name

CHILD 1: Grade Entering in the Fall

CHILD 1: Select the Weeks You Plan to Attend

Please check ALL that apply. You are not bound to attend all weeks selected but knowing your intentions allows us to prepare for you that week.

CHILD 1: Special Health Concerns

Please indicate any health concerns that your child's counselors and teachers should know in order to keep them safe throughout the day. This information will be given to all staff members.

CHILD 1: Did This Child Attend in 2014?

If Yes, please indicate their group and/or teacher from 2014

CHILD 1: Did This Child Attend CBCA 2014-2015?

If Yes, please indicate their teacher.

CHILD 1: T-Shirt Size

If you are registering before May 3rd you are eligible for a free t-shirt.

Child 2

CHILD 2: First and Last Name

CHILD 2: Grade Entering in the Fall

CHILD 2: Select the Weeks You Plan to Attend

Please check ALL that apply. You are not bound to attend all weeks selected but knowing your intentions allows us to prepare for you that week.

CHILD 2: Special Health Concerns

Please indicate any health concerns that your child's counselors and teachers should know in order to keep them safe throughout the day. This information will be given to all staff members.

CHILD 2: Did This Child Attend in 2014?

If Yes, please indicate their group and/or teacher from 2014

CHILD 2: Did This Child Attend CBCA 2014-2015?

If Yes, please indicate their teacher.

CHILD 2: T-Shirt Size

If you are registering before May 3rd you are eligible for a free t-shirt.

Child 3

CHILD 3: First and Last Name

CHILD 3: Grade Entering in the Fall

CHILD 3: Select the Weeks You Plan to Attend

Please check ALL that apply. You are not bound to attend all weeks selected but knowing your intentions allows us to prepare for you that week.

CHILD 3: Special Health Concerns

Please indicate any health concerns that your child's counselors and teachers should know in order to keep them safe throughout the day. This information will be given to all staff members.

CHILD 3: Did This Child Attend in 2014?

If Yes, please indicate their group and/or teacher from 2014

CHILD 3: Did This Child Attend CBCA 2014-2015?

If Yes, please indicate their teacher.

CHILD 3: T-Shirt Size

If you are registering before May 3rd you are eligible for a free t-shirt.

Child 4

CHILD 4: First and Last Name

CHILD 4: Grade Entering in the Fall

CHILD 4: Select the Weeks You Plan to Attend

Please check ALL that apply. You are not bound to attend all weeks selected but knowing your intentions allows us to prepare for you that week.

CHILD 4: Special Health Concerns

Please indicate any health concerns that your child's counselors and teachers should know in order to keep them safe throughout the day. This information will be given to all staff members.

CHILD 4: Did This Child Attend in 2014?

If Yes, please indicate their group and/or teacher from 2014

CHILD 4: Did This Child Attend CBCA 2014-2015?

If Yes, please indicate their teacher.

CHILD 4: T-Shirt Size

If you are registering before May 3rd you are eligible for a free t-shirt.

AUTHORIZED PICK UP INFORMATION

Please indicate ALL people who have permission to pick up your children enrolled in our program. Please include Names of all Parents/Step Parents and other legal guardians who have permission to pick up.

AUTHORIZED PERSON 1: Name and Phone Number

AUTHORIZED PERSON 2: Name and Phone Number

AUTHORIZED PERSON 3: Name and Phone Number

AUTHORIZED PERSON 4: Name and Phone Number

AUTHORIZED PERSON 5: Name and Phone Number

AUTHORIZED PERSON 6: Name and Phone Number

AUTHORIZED PERSON 7: Name and Phone Number

AUTHORIZED PERSON 8: Name and Phone Number

NEXT STEPS

Please download and sign the field trip and activities permission slip and include it with your $40 registration fee. The permission slip and fee may be either dropped of in person or mailed to: Calvary Summer Session Attn: Lydia Henderson 407 Marley Station Road Glen Burnie, Maryland 21060

Calvary Summer Session

Creating summer memories in a safe & christ-centered environment

Overview